MEDICARE: MONARCH WOUND CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1124806831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONARCH WOUND CARE LLC

Provider Business Mailing Address
First Line	:	200 FORT PIERPONT DR STE 105
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-1327
Country	:	US
Telephone Number	:	304-241-7667
Fax Number	:	304-241-7568

Provider Business Practice Location Address
First Line	:	200 FORT PIERPONT DR STE 105
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-1327
Country	:	US
Telephone Number	:	304-241-7667
Fax Number	:	304-241-7568

Authorized Official
Title or Position	:	OWNER, PROVIDER
Name	:	JACQUELINE J GAY
Credential	:	DPT, CWS
Telephone Number	:	304-241-7667

Provider Enumeration Date	:	09/15/2023
Last Update Date	:	09/15/2023

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