Healthcare Provider Details

I. General information

NPI: 1558423152
Provider Name (Legal Business Name): ADAM G WEST BS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER HARDING RT 10 COOK PKWY
OCEANA WV
24870
US

IV. Provider business mailing address

1263 TREASURE LK
DU BOIS PA
15801-9053
US

V. Phone/Fax

Practice location:
  • Phone: 304-682-7100
  • Fax: 304-682-7400
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002377
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number010351
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number013327L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: