Healthcare Provider Details

I. General information

NPI: 1093741837
Provider Name (Legal Business Name): BOLIVAR-HARPERS FERRY PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 PANAMA ST
HARPERS FERRY WV
25425
US

IV. Provider business mailing address

PO BOX 902
HARPERS FERRY WV
25425-0902
US

V. Phone/Fax

Practice location:
  • Phone: 304-535-2400
  • Fax: 304-535-2424
Mailing address:
  • Phone: 304-535-2400
  • Fax: 304-535-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number001785
License Number StateWV

VIII. Authorized Official

Name: HEIDI SIMMONS
Title or Position: PHYSICAL THERAPIST, OWNER
Credential: MSPT
Phone: 304-535-2400