Provider Demographics
NPI:1750826988
Name:L'HOMMEDIEU PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:L'HOMMEDIEU PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:304-276-8301
Mailing Address - Street 1:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26542-0226
Mailing Address - Country:US
Mailing Address - Phone:304-276-8301
Mailing Address - Fax:
Practice Address - Street 1:356 STURGISS SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:WV
Practice Address - Zip Code:26542-9520
Practice Address - Country:US
Practice Address - Phone:304-276-8301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-26
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV021452251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty