Healthcare Provider Details

I. General information

NPI: 1215375415
Provider Name (Legal Business Name): ADVANCED PHYSICAL MEDICINE OF WEST VIRGINIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 BURROUGHS ST
MORGANTOWN WV
26505-3346
US

IV. Provider business mailing address

699 BURROUGHS ST
MORGANTOWN WV
26505-3346
US

V. Phone/Fax

Practice location:
  • Phone: 304-225-9356
  • Fax: 304-225-9358
Mailing address:
  • Phone: 304-225-9356
  • Fax: 304-241-4510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTYN BILLINGS
Title or Position: CREDENTIALING
Credential:
Phone: 412-655-4362