1861632705 NPI number — TEAYS PHYSICAL THERAPY CENTER, INC.

Table of content: (NPI 1861632705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861632705 NPI number — TEAYS PHYSICAL THERAPY CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEAYS PHYSICAL THERAPY CENTER, 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:
1861632705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3910 TEAYS VALLEY ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURRICANE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25526-9756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-757-7293
Provider Business Mailing Address Fax Number:
304-757-0574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 B ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAINT ALBANS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25177-2727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-727-7293
Provider Business Practice Location Address Fax Number:
304-727-3223
Provider Enumeration Date:
03/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SKILES
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-757-7293

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4000474000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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