Provider Demographics
NPI:1477735090
Name:MCGINNIS, BEVERLY NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:NICOLE
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:NICOLE
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:16 STERLING DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9133
Mailing Address - Country:US
Mailing Address - Phone:681-342-2133
Mailing Address - Fax:
Practice Address - Street 1:1600 MURDOCH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3248
Practice Address - Country:US
Practice Address - Phone:304-485-8040
Practice Address - Fax:304-485-4883
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT010133225100000X
FLPT30196225100000X
WV002659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810011451Medicaid
FL016202100Medicaid
OH2544572Medicaid
FL016202100Medicaid
4141802Medicare PIN