Provider Demographics
NPI:1922245711
Name:PERSONAL TOUCH PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PERSONAL TOUCH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:304-253-1130
Mailing Address - Street 1:1038 N EISENHOWER DR
Mailing Address - Street 2:PMB 291
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3116
Mailing Address - Country:US
Mailing Address - Phone:304-253-1130
Mailing Address - Fax:304-253-1150
Practice Address - Street 1:217 BROOKSHIRE LN
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6729
Practice Address - Country:US
Practice Address - Phone:304-253-1130
Practice Address - Fax:304-253-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT002068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty