Provider Demographics
NPI:1295277218
Name:ELKINS PHYSICAL THERAPY SERVICE, INC.
Entity type:Organization
Organization Name:ELKINS PHYSICAL THERAPY SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-636-2340
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-0003
Mailing Address - Country:US
Mailing Address - Phone:304-636-2340
Mailing Address - Fax:304-636-1583
Practice Address - Street 1:1520 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-8500
Practice Address - Country:US
Practice Address - Phone:304-636-2340
Practice Address - Fax:304-636-1583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT002503261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy