Provider Demographics
NPI:1831324797
Name:OSBORNE, MICHAEL RAY (PTA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAY
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4762 COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CYCLONE
Mailing Address - State:WV
Mailing Address - Zip Code:24827-9438
Mailing Address - Country:US
Mailing Address - Phone:304-923-3673
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 92 AT ROUTE 60
Practice Address - Street 2:GENESIS HEALTHCARE
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24986
Practice Address - Country:US
Practice Address - Phone:304-536-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001423225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant