MEDICARE: PENDLETON OUTPATIENT THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518164813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENDLETON OUTPATIENT THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 700
Second Line	:
City	:	FRANKLIN
State	:	WV
Zip	:	26807-0700
Country	:	US
Telephone Number	:	304-358-2322
Fax Number	:	304-358-2324

Provider Business Practice Location Address
First Line	:	68 GOOD SAMARITAN DRIVE
Second Line	:
City	:	FRANKLIN
State	:	WV
Zip	:	26807-0700
Country	:	US
Telephone Number	:	304-358-2322
Fax Number	:	304-358-2334

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	CYNTHIA SITES
Credential	:
Telephone Number	:	304-358-2322

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	03/15/2022

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Directions to “PENDLETON OUTPATIENT THERAPY ” Practice Location

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