Provider Demographics
NPI:1013036011
Name:IRONTON PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:IRONTON PHYSICAL THERAPY INC
Other - Org Name:TRI STATE REHAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:SHAE
Authorized Official - Last Name:RITCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-324-0540
Mailing Address - Street 1:2700 GREENUP AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-1953
Mailing Address - Country:US
Mailing Address - Phone:606-324-0540
Mailing Address - Fax:606-324-0616
Practice Address - Street 1:4120 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-1127
Practice Address - Country:US
Practice Address - Phone:304-429-7381
Practice Address - Fax:304-429-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2632244Medicaid
WV3810004569Medicaid
WV3810004569Medicaid
OH2632244Medicaid