Provider Demographics
NPI:1891825360
Name:MASTERWORKS INC
Entity Type:Organization
Organization Name:MASTERWORKS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SYVERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,CFT,CCI,CWCHP
Authorized Official - Phone:304-573-6858
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832-0767
Mailing Address - Country:US
Mailing Address - Phone:304-573-6858
Mailing Address - Fax:
Practice Address - Street 1:156 BROOK LN
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832-9693
Practice Address - Country:US
Practice Address - Phone:304-573-6858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2014-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0001489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV87316OtherUNICARE
WV9420008-000Medicaid
WV1064530OtherWORKERSCOMP/BRICKSTREET
WV612406500OtherDOL FECA
WV001706475OtherMSBCBS- GROUP PIN
WV001714553OtherMSBCBS- GREGORY SYVERTSON
WVM134278OtherINTEGRATED HEALTH PLAN INC
WV5534228OtherFIRST HEALTH
WV697891OtherUNITED HEALTHCARE
WV87316OtherUNICARE
WVMA9343511Medicare PIN