Provider Demographics
NPI:1164669537
Name:QUALITY PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:QUALITY PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:K
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:304-545-2152
Mailing Address - Street 1:510 N OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4461
Mailing Address - Country:US
Mailing Address - Phone:304-545-2152
Mailing Address - Fax:866-262-4450
Practice Address - Street 1:3875 ROBERT C BYRD DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2964
Practice Address - Country:US
Practice Address - Phone:304-545-2152
Practice Address - Fax:866-262-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty