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General NPI Number Information
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NPI Number | 1730727090
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Entity Type | Organization
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Legal Business Name | IMPACT PHYSICAL THERAPY AND REHABILITATION
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 3200 MAIN ST
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City | MORGANTOWN
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State | PA
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Zip | 19543-7700
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Country | US
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Telephone | 610-286-0004
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Fax | 610-601-3616
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Provider Business Mailing Address
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Address Line | PO BOX 416
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City | MORGANTOWN
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State | PA
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Zip | 19543-0416
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Country | US
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Telephone | 610-286-0004
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Fax | 610-601-3616
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | COLE CHAMBERLIN
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Credential | DPT
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Telephone | 845-820-2295
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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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