Healthcare Provider Details

I. General information

NPI: 1801338827
Provider Name (Legal Business Name): ELK VALLEY PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CREDES LNDG
ELKVIEW WV
25071-8185
US

IV. Provider business mailing address

105 CREDES LNDG
ELKVIEW WV
25071-8185
US

V. Phone/Fax

Practice location:
  • Phone: 304-965-7979
  • Fax: 304-965-3239
Mailing address:
  • Phone: 304-965-7979
  • Fax: 304-965-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001912
License Number StateWV

VIII. Authorized Official

Name: AMBER DAWN CASTO
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-965-7979