Provider Demographics
NPI:1811011109
Name:HIDDEN VALLEY NSG AND REHABCTR.
Entity Type:Organization
Organization Name:HIDDEN VALLEY NSG AND REHABCTR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPTA
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-465-1903
Mailing Address - Street 1:139 RICHARDS ST
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-2153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:422 23RD ST
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2830
Practice Address - Country:US
Practice Address - Phone:304-465-1903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV481225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty