Provider Demographics
NPI:1861493314
Name:BARBOURSVILLE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BARBOURSVILLE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO.PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:304-736-3094
Mailing Address - Street 1:6433 US ROUTE 60 E
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1226
Mailing Address - Country:US
Mailing Address - Phone:304-736-3094
Mailing Address - Fax:304-736-3149
Practice Address - Street 1:6433 US ROUTE 60 E
Practice Address - Street 2:SUITE 125
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1226
Practice Address - Country:US
Practice Address - Phone:304-736-3094
Practice Address - Fax:304-736-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CD9690OtherRR MEDICARE
WV9420081000Medicaid
WV9420081000Medicaid
9291182Medicare ID - Type Unspecified