Provider Demographics
NPI:1013039965
Name:PHYSICAL THERAPY PROVIDERS PLLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY PROVIDERS PLLC
Other - Org Name:PT PROVIDERS PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SCHIRMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-273-8071
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:RAVENSWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26164
Mailing Address - Country:US
Mailing Address - Phone:304-273-8071
Mailing Address - Fax:304-273-8015
Practice Address - Street 1:240 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164
Practice Address - Country:US
Practice Address - Phone:304-273-8071
Practice Address - Fax:304-273-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001137261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0240611000Medicaid
WV0240611000Medicaid
1427110717Medicare UPIN
IB080352Medicare ID - Type Unspecified