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General NPI Number Information
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NPI Number | 1003994054
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Entity Type | Organization
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Legal Business Name | FAYETTEVILLE PHYSICAL THERAPY & SPORTS REHABILITATION
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 233 N COURT ST
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City | FAYETTEVILLE
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State | WV
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Zip | 25840-1233
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Country | US
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Telephone | 304-574-1416
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Fax | 304-574-1474
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Provider Business Mailing Address
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Address Line | 233 N COURT ST
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City | FAYETTEVILLE
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State | WV
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Zip | 25840-1233
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Country | US
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Telephone | 304-574-1416
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Fax | 304-574-1474
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KAREN M BRANDSTETTER
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Credential |
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Telephone | 304-574-1416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | WV902
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License Number State | WV
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