Provider Demographics
NPI:1134256506
Name:CAMC SPORTS MEDICINE AND REHAB--CROSS LANES
Entity type:Organization
Organization Name:CAMC SPORTS MEDICINE AND REHAB--CROSS LANES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ATC
Authorized Official - Phone:304-388-7055
Mailing Address - Street 1:325 CHEROKEE TRL
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-4105
Mailing Address - Country:US
Mailing Address - Phone:304-222-2112
Mailing Address - Fax:
Practice Address - Street 1:130 GOFF MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1419
Practice Address - Country:US
Practice Address - Phone:304-388-7055
Practice Address - Fax:305-388-7058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy