Healthcare Provider Details

I. General information

NPI: 1952063224
Provider Name (Legal Business Name): GENERATIONS R.C. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 40TH STREET
NITRO WV
25143
US

IV. Provider business mailing address

PO BOX 219
MILTON WV
25541-0219
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-2500
  • Fax:
Mailing address:
  • Phone: 681-233-0753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TERRY MUNDELL
Title or Position: CFO
Credential:
Phone: 681-233-0753