Healthcare Provider Details

I. General information

NPI: 1912061482
Provider Name (Legal Business Name): CARLA A MCGINNIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER HARDING & RT.10 COOK PARKWAY
OCEANA WV
24870
US

IV. Provider business mailing address

807 W BOYD ST
GRAFTON WV
26354-1142
US

V. Phone/Fax

Practice location:
  • Phone: 304-682-7100
  • Fax: 304-682-7400
Mailing address:
  • Phone: 304-265-3760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001543
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: