MEDICARE: AFFILIATED PHYSICAL THERAPY 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	:	1851680425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFILIATED PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	2A CHERRY TREE DR
Second Line	:
City	:	NUTTER FORT
State	:	WV
Zip	:	26301-4475
Country	:	US
Telephone Number	:	304-622-5822
Fax Number	:	304-622-9707

Provider Business Practice Location Address
First Line	:	2A CHERRY TREE DR
Second Line	:
City	:	NUTTER FORT
State	:	WV
Zip	:	26301-4475
Country	:	US
Telephone Number	:	304-622-5822
Fax Number	:	304-622-9707

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. BARBARA LYNN LUNSFORD
Credential	:
Telephone Number	:	304-622-5822

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	04/04/2011

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