Provider Demographics
NPI:1457030678
Name:COMPOSITE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:COMPOSITE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KEPFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:772-971-2693
Mailing Address - Street 1:982 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-6918
Mailing Address - Country:US
Mailing Address - Phone:772-971-2693
Mailing Address - Fax:
Practice Address - Street 1:982 GRAND ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-6918
Practice Address - Country:US
Practice Address - Phone:772-971-2693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty