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General NPI Number Information
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NPI Number | 1982993325
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Entity Type | Organization
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Legal Business Name | THE BIOMECHANICS INSTITUTE
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 417 GRAND PARK DR SUITE 103
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City | PARKERSBURG
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State | WV
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Zip | 26105-4049
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Country | US
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Telephone | 304-834-3905
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Fax | 304-917-3905
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Provider Business Mailing Address
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Address Line | 517 MARIETTA LN
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City | MARIETTA
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State | OH
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Zip | 45750-1917
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Country | US
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Telephone | 740-336-7022
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DEREK HOLLINGSWORTH
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Credential | DO
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Telephone | 304-834-3905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2360
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License Number State | WV
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