Provider Demographics
NPI:1578828844
Name:ENTERPRISE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ENTERPRISE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:304-562-2823
Mailing Address - Street 1:242 IRENE CIR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9320
Mailing Address - Country:US
Mailing Address - Phone:304-562-2823
Mailing Address - Fax:304-562-2823
Practice Address - Street 1:242 IRENE CIR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9320
Practice Address - Country:US
Practice Address - Phone:304-562-2823
Practice Address - Fax:304-562-2823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV99UEU261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy