Healthcare Provider Details

I. General information

NPI: 1366156689
Provider Name (Legal Business Name): MY PT EMR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 01/11/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 MARA ROSE LN
HARPERS FERRY WV
25425-9509
US

IV. Provider business mailing address

384 MARA ROSE LN
HARPERS FERRY WV
25425-9509
US

V. Phone/Fax

Practice location:
  • Phone: 903-944-9138
  • Fax:
Mailing address:
  • Phone: 903-944-9138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name: ADAM A POURNARAS
Title or Position: VICE PRESIDENT
Credential:
Phone: 724-513-1256