Healthcare Provider Details

I. General information

NPI: 1144268467
Provider Name (Legal Business Name): ADAM T WEST P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 WALNUT ST
SHINNSTON WV
26431-1154
US

IV. Provider business mailing address

719 FAIRMONT AVE SUITE 102
FAIRMONT WV
26554-5118
US

V. Phone/Fax

Practice location:
  • Phone: 304-592-5042
  • Fax: 304-592-5043
Mailing address:
  • Phone: 304-363-8543
  • Fax: 304-363-0173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002347
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: