Provider Demographics
NPI:1518164813
Name:PENDLETON OUTPATIENT THERAPY
Entity Type:Organization
Organization Name:PENDLETON OUTPATIENT THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SITES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-358-2322
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WV
Mailing Address - Zip Code:26807-0700
Mailing Address - Country:US
Mailing Address - Phone:304-358-2322
Mailing Address - Fax:304-358-2324
Practice Address - Street 1:68 GOOD SAMARITAN DRIVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WV
Practice Address - Zip Code:26807-0700
Practice Address - Country:US
Practice Address - Phone:304-358-2322
Practice Address - Fax:304-358-2334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003817002Medicaid
WV0003817002Medicaid