1457432296 NPI number — SHENANDOAH VALLEY PHYSICAL THERAPY & SPORTS MEDICINE, INC.

Table of content: (NPI 1457432296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457432296 NPI number — SHENANDOAH VALLEY PHYSICAL THERAPY & SPORTS MEDICINE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHENANDOAH VALLEY PHYSICAL THERAPY & SPORTS MEDICINE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457432296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 ROCK CLIFF DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARTINSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25401-2838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-267-0866
Provider Business Mailing Address Fax Number:
304-267-8348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 ROCK CLIFF DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25401-2838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-267-0866
Provider Business Practice Location Address Fax Number:
304-267-8348
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RANKIN
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BUSINESS MANAGER/OWNER
Authorized Official Telephone Number:
304-267-0866

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  028075 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001710137 . This is a "BCBS-MT STATE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 151474500 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2137778 . This is a "MAMSI" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 9565 . This is a "BCBS-CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3810005986 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0BGGSH . This is a "BCBS-CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1024916 . This is a "BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 415580700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8721526 . This is a "CIGNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 224049 . This is a "CARELINK" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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