=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861493314
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARBOURSVILLE PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6433 US ROUTE 60 E SUITE 125
-----------------------------------------------------
City | BARBOURSVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25504-1226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-736-3094
-----------------------------------------------------
Fax | 304-736-3149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6433 US ROUTE 60 E SUITE 125
-----------------------------------------------------
City | BARBOURSVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25504-1226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-736-3094
-----------------------------------------------------
Fax | 304-736-3149
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO.PARTNER
-----------------------------------------------------
Name | MR. JOSEPH R CROWDER
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 304-736-3094
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------