Healthcare Provider Details

I. General information

NPI: 1174526800
Provider Name (Legal Business Name): PAUL K CALVERT P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 ERIN DR
MORGANTOWN WV
26508-1371
US

IV. Provider business mailing address

PO BOX 6230
WHEELING WV
26003-0722
US

V. Phone/Fax

Practice location:
  • Phone: 304-594-2500
  • Fax: 304-594-9310
Mailing address:
  • Phone: 304-242-7106
  • Fax: 304-242-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number001435
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5731
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001435
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: