Healthcare Provider Details

I. General information

NPI: 1669545687
Provider Name (Legal Business Name): MAINSTREAM PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 THREE SPRINGS DR STE 1
WEIRTON WV
26062-3839
US

IV. Provider business mailing address

243 THREE SPRINGS DR STE 1
WEIRTON WV
26062-3839
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-7111
  • Fax: 304-723-7173
Mailing address:
  • Phone: 304-723-7111
  • Fax: 304-723-7173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number002305
License Number StateWV

VIII. Authorized Official

Name: JOHN IRA KIRLANGITIS
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: DPT
Phone: 304-723-7111