Provider Demographics
NPI:1750454757
Name:AMRINE, LOUISE A (PT)
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:A
Last Name:AMRINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PINNACLE LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-2918
Mailing Address - Country:US
Mailing Address - Phone:304-594-2111
Mailing Address - Fax:304-366-9380
Practice Address - Street 1:RT 3 BOX 338B
Practice Address - Street 2:WINFIELD STATE RT 73
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-366-1299
Practice Address - Fax:304-366-9380
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWC1003703002OtherBRICKSTREET
WV0155958000Medicaid
WV550695082OtherEIN