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General NPI Number Information
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NPI Number | 1093741837
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Entity Type | Organization
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Legal Business Name | BOLIVAR-HARPERS FERRY PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 11/13/2012
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Provider Practice Location Address
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Address Line | 43 PANAMA ST
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City | HARPERS FERRY
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State | WV
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Zip | 25425
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Country | US
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Telephone | 304-535-2400
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Fax | 304-535-2424
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Provider Business Mailing Address
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Address Line | PO BOX 902
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City | HARPERS FERRY
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State | WV
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Zip | 25425-0902
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Country | US
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Telephone | 304-535-2400
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Fax | 304-535-2424
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | HEIDI SIMMONS
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Credential | MSPT
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Telephone | 304-535-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 001785
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License Number State | WV
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