Provider Demographics
NPI:1568788149
Name:HECTORS PHYSICAL THERAPY CLINIC LLC
Entity Type:Organization
Organization Name:HECTORS PHYSICAL THERAPY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ETTORE
Authorized Official - Middle Name:(HECTOR)
Authorized Official - Last Name:PITTORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:304-963-0324
Mailing Address - Street 1:4530 5TH STREET RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-9564
Mailing Address - Country:US
Mailing Address - Phone:304-525-4782
Mailing Address - Fax:304-525-4782
Practice Address - Street 1:4530 5TH STREET RD
Practice Address - Street 2:UNIT B
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-9564
Practice Address - Country:US
Practice Address - Phone:304-525-4782
Practice Address - Fax:304-525-4782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0970261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy