Provider Demographics
NPI:1164564670
Name:DOCTORS CHOICE REHABILITATION CLINIC
Entity Type:Organization
Organization Name:DOCTORS CHOICE REHABILITATION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-363-4133
Mailing Address - Street 1:161 MIDDLETOWN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2015
Mailing Address - Country:US
Mailing Address - Phone:304-363-4133
Mailing Address - Fax:304-363-4183
Practice Address - Street 1:161 MIDDLETOWN CIRCLE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2015
Practice Address - Country:US
Practice Address - Phone:304-363-4133
Practice Address - Fax:304-363-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4001041000Medicaid
WV9312201Medicare ID - Type Unspecified