Provider Demographics
NPI:1710191671
Name:BUCKHANNON MEDICAL REHABILITATION AND MASSAGE THERAPY
Entity Type:Organization
Organization Name:BUCKHANNON MEDICAL REHABILITATION AND MASSAGE THERAPY
Other - Org Name:ELKINS PAIN REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REHABILITATION
Authorized Official - Prefix:DR
Authorized Official - First Name:CORTNEY
Authorized Official - Middle Name:LANE TAYLOR
Authorized Official - Last Name:FELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:304-636-5777
Mailing Address - Street 1:1200 HARRISON AVE
Mailing Address - Street 2:SUITE G20
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3394
Mailing Address - Country:US
Mailing Address - Phone:304-636-5777
Mailing Address - Fax:
Practice Address - Street 1:1200 HARRISON AVE
Practice Address - Street 2:SUITE G20
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3394
Practice Address - Country:US
Practice Address - Phone:304-636-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV002529261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy