Provider Demographics
NPI:1558791020
Name:ORTHOPEDIC AND SPORTS PHYSICAL THERAPY ASSOC INC
Entity Type:Organization
Organization Name:ORTHOPEDIC AND SPORTS PHYSICAL THERAPY ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS
Authorized Official - Phone:724-483-3610
Mailing Address - Street 1:625 LINCOLN AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:N CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-2451
Mailing Address - Country:US
Mailing Address - Phone:724-483-2159
Mailing Address - Fax:724-489-4758
Practice Address - Street 1:3109 UNIVERSITY AVE STE C
Practice Address - Street 2:SELLARO PLAZA
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3205
Practice Address - Country:US
Practice Address - Phone:304-241-4020
Practice Address - Fax:304-241-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVOC000858L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty