Healthcare Provider Details

I. General information

NPI: 1265969455
Provider Name (Legal Business Name): GENERATIONS R.C. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 KANAWHA BLVD W STE 300
CHARLESTON WV
25302-2350
US

IV. Provider business mailing address

100 PEYTON WAY STE 100
SOUTH CHARLESTON WV
25309-8545
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-2500
  • Fax:
Mailing address:
  • Phone: 304-757-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRENDA TARR
Title or Position: CFO
Credential:
Phone: 304-743-4954