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General NPI Number Information
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NPI Number | 1134256506
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Entity Type | Organization
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Legal Business Name | CAMC SPORTS MEDICINE AND REHAB--CROSS LANES
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 130 GOFF MOUNTAIN RD
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City | CROSS LANES
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State | WV
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Zip | 25313-1419
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Country | US
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Telephone | 304-388-7055
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Fax | 305-388-7058
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Provider Business Mailing Address
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Address Line | 325 CHEROKEE TRL
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City | HUNTINGTON
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State | WV
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Zip | 25705-4105
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Country | US
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Telephone | 304-222-2112
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Fax |
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Authorized Official
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Title or Position | ATHLETIC TRAINER
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Name | MISS ALLISON ELIZABETH COLE
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Credential | MS, ATC
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Telephone | 304-388-7055
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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 |
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License Number State |
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