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General NPI Number Information
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NPI Number | 1093358616
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Entity Type | Organization
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Legal Business Name | CAPITAL PHYSICAL THERAPY AND FITNESS LLC
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Dates
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Enumeration Date | 10/26/2019
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 4216 MACCORKLE AVE SE STE 4
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City | CHARLESTON
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State | WV
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Zip | 25304-2539
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Country | US
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Telephone | 304-926-9091
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Fax | 304-926-0914
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Provider Business Mailing Address
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Address Line | 4216 MACCORKLE AVE SE STE 4
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City | CHARLESTON
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State | WV
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Zip | 25304-2539
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Country | US
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Telephone | 304-926-0913
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Fax |
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Authorized Official
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Title or Position | CEO, PT
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Name | MATTHEW TAYLOR
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Credential | PT, DPT, CSCS, CLT
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Telephone | 304-926-0913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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