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General NPI Number Information
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NPI Number | 1558371328
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Entity Type | Organization
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Legal Business Name | WEST VIRGINIA PHYSICAL THERAPY & WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 717 N JEFFERSON ST
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City | LEWISBURG
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State | WV
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Zip | 24901-9506
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Country | US
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Telephone | 304-645-2525
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Fax | 304-645-2820
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Provider Business Mailing Address
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Address Line | 717 N JEFFERSON ST
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City | LEWISBURG
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State | WV
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Zip | 24901-9506
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Country | US
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Telephone | 304-645-2525
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Fax | 304-645-2820
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Authorized Official
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Title or Position | CO. OWNER
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Name | MRS. GEORGEANN MARIE BLANKENSHIP
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Credential |
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Telephone | 304-645-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 71364
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License Number State | WV
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