Provider Demographics
NPI:1104034073
Name:RANKIN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:RANKIN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STREETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-699-9395
Mailing Address - Street 1:PO BOX 932184
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-2184
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 FITNESS LN
Practice Address - Street 2:
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-7080
Practice Address - Country:US
Practice Address - Phone:304-258-1300
Practice Address - Fax:304-258-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV006006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1055460OtherBRICKSTREET
WI6935357OtherCIGNA
WV225211OtherCARELINK
WV205384100OtherUS DEPT OF LABOR
WV001711146OtherBCBS
WV696797OtherUNITED HEALTH CARE
WV292354OtherMAMSI
MD0699RAOtherBCBS
MDA815OtherBCBS
WV3810010828Medicaid
MD403650600Medicaid
MD0699RAOtherBCBS
WV225211OtherCARELINK