1669545687 NPI number — MAINSTREAM PHYSICAL THERAPY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669545687 NPI number — MAINSTREAM PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAINSTREAM PHYSICAL THERAPY LLC
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:
1669545687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
243 THREE SPRINGS DR STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEIRTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26062-3839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-723-7111
Provider Business Mailing Address Fax Number:
304-723-7173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
243 THREE SPRINGS DR STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEIRTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26062-3839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-723-7111
Provider Business Practice Location Address Fax Number:
304-723-7173
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIRLANGITIS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
IRA
Authorized Official Title or Position:
DOCTOR OF PHYSICAL THERAPY
Authorized Official Telephone Number:
304-723-7111

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  002305 , 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: 3810001308 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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