Healthcare Provider Details

I. General information

NPI: 1134256506
Provider Name (Legal Business Name): CAMC SPORTS MEDICINE AND REHAB--CROSS LANES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 GOFF MOUNTAIN RD
CROSS LANES WV
25313-1419
US

IV. Provider business mailing address

325 CHEROKEE TRL
HUNTINGTON WV
25705-4105
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7055
  • Fax: 305-388-7058
Mailing address:
  • Phone: 304-222-2112
  • Fax:

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: MISS ALLISON ELIZABETH COLE
Title or Position: ATHLETIC TRAINER
Credential: MS, ATC
Phone: 304-388-7055