Healthcare Provider Details

I. General information

NPI: 1326243890
Provider Name (Legal Business Name): MOUNTAIN RIVER PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 COMMERCE ST
WELLSBURG WV
26070-1528
US

IV. Provider business mailing address

415 36TH ST SUITE 100
PARKERSBURG WV
26101-1005
US

V. Phone/Fax

Practice location:
  • Phone: 304-737-0437
  • Fax: 304-737-0581
Mailing address:
  • Phone: 304-917-3676
  • Fax: 304-917-3674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BURTON R REED
Title or Position: OWNER-PHYSICAL THERAPIST
Credential: PT
Phone: 304-865-6778