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General NPI Number Information
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NPI Number | 1326849365
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Entity Type | Organization
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Legal Business Name | CORRIDOR H PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 4 RIGHT SAW MILL RD
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City | HORNER
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State | WV
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Zip | 26372-9743
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Country | US
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Telephone | 304-997-4041
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34
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City | HORNER
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State | WV
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Zip | 26372-0034
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JERRY STOUT
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Credential |
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Telephone | 304-439-0777
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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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