Healthcare Provider Details

I. General information

NPI: 1407165830
Provider Name (Legal Business Name): MOUNTAIN RIVER PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 DEPOT STREET
CHATHAM VA
24531-0000
US

IV. Provider business mailing address

415 36TH ST SUITE 100
PARKERSBURG WV
26101-1005
US

V. Phone/Fax

Practice location:
  • Phone: 304-865-6778
  • Fax: 304-865-7400
Mailing address:
  • Phone: 304-917-3660
  • Fax: 304-917-3674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BURTON RICHARD REED
Title or Position: OWNER
Credential: PT, OCS, FAAOMPT
Phone: 304-865-6778