Provider Demographics
NPI:1891806949
Name:PHYSICAL & OCCUPATIONAL THERAPY SERVICES INC.
Entity Type:Organization
Organization Name:PHYSICAL & OCCUPATIONAL THERAPY SERVICES INC.
Other - Org Name:PRO 1 THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:276-326-3611
Mailing Address - Street 1:111B SANDERS LANE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-9278
Mailing Address - Country:US
Mailing Address - Phone:276-326-3611
Mailing Address - Fax:276-322-2850
Practice Address - Street 1:111B SANDERS LANE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-9278
Practice Address - Country:US
Practice Address - Phone:276-326-3611
Practice Address - Fax:276-322-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225200000X, 225X00000X
WV0025672251S0007X
VA23052024182251X0800X
VA0501020532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0156094000Medicaid
WV0159770000Medicaid
036077OtherANTHEM BCBS
054378OtherANTHEM BCBS
WV0159770000Medicaid