Provider Demographics
NPI:1497362867
Name:PELVIC HEALTH PHYSICAL THERAPY OF MORGANTOWN, LLC
Entity Type:Organization
Organization Name:PELVIC HEALTH PHYSICAL THERAPY OF MORGANTOWN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-730-0074
Mailing Address - Street 1:801 TIMBER BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1622
Mailing Address - Country:US
Mailing Address - Phone:304-282-6497
Mailing Address - Fax:888-461-5707
Practice Address - Street 1:6000 COOMBS FARM RD STE 106
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1155
Practice Address - Country:US
Practice Address - Phone:304-282-6497
Practice Address - Fax:888-461-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy