Healthcare Provider Details

I. General information

NPI: 1457432296
Provider Name (Legal Business Name): SHENANDOAH VALLEY PHYSICAL THERAPY & SPORTS MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 ROCK CLIFF DR
MARTINSBURG WV
25401-2838
US

IV. Provider business mailing address

302 ROCK CLIFF DR
MARTINSBURG WV
25401-2838
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-0866
  • Fax: 304-267-8348
Mailing address:
  • Phone: 304-267-0866
  • Fax: 304-267-8348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number028075
License Number StateWV

VIII. Authorized Official

Name: MRS. JENNIFER L RANKIN
Title or Position: BUSINESS MANAGER/OWNER
Credential:
Phone: 304-267-0866