Healthcare Provider Details

I. General information

NPI: 1568788149
Provider Name (Legal Business Name): HECTORS PHYSICAL THERAPY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 5TH STREET RD UNIT B
HUNTINGTON WV
25701-9564
US

IV. Provider business mailing address

4530 5TH STREET RD UNIT B
HUNTINGTON WV
25701-9564
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-4782
  • Fax: 304-525-4782
Mailing address:
  • Phone: 304-525-4782
  • Fax: 304-525-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0970
License Number StateWV

VIII. Authorized Official

Name: MR. ETTORE (HECTOR) PITTORE
Title or Position: SOLE OWNER
Credential: P.T.
Phone: 304-963-0324