Provider Demographics
NPI:1093050809
Name:FORTITUDE PHYSICAL THERAPY & REHABILITATION LLC
Entity Type:Organization
Organization Name:FORTITUDE PHYSICAL THERAPY & REHABILITATION LLC
Other - Org Name:FORTITUDE PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SEEGEE
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:BACHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:304-789-3000
Mailing Address - Street 1:1779 ALPINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TERRA ALTA
Mailing Address - State:WV
Mailing Address - Zip Code:26764-6999
Mailing Address - Country:US
Mailing Address - Phone:304-789-3000
Mailing Address - Fax:304-212-2584
Practice Address - Street 1:1779 ALPINE LAKE RD
Practice Address - Street 2:
Practice Address - City:TERRA ALTA
Practice Address - State:WV
Practice Address - Zip Code:26764-6999
Practice Address - Country:US
Practice Address - Phone:304-789-3000
Practice Address - Fax:304-212-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002798261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy