Healthcare Provider Details

I. General information

NPI: 1831309632
Provider Name (Legal Business Name): BETHANY ANN POORE DPT, ATC, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WEATHERHOLT DR
ONA WV
25545-9306
US

IV. Provider business mailing address

130 CHEYENNE TRL
ONA WV
25545-9754
US

V. Phone/Fax

Practice location:
  • Phone: 304-390-5705
  • Fax:
Mailing address:
  • Phone: 304-390-5705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT002647
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: