Provider Demographics
NPI:1457432296
Name:SHENANDOAH VALLEY PHYSICAL THERAPY & SPORTS MEDICINE, INC.
Entity Type:Organization
Organization Name:SHENANDOAH VALLEY PHYSICAL THERAPY & SPORTS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:RANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-267-0866
Mailing Address - Street 1:302 ROCK CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2838
Mailing Address - Country:US
Mailing Address - Phone:304-267-0866
Mailing Address - Fax:304-267-8348
Practice Address - Street 1:302 ROCK CLIFF DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2838
Practice Address - Country:US
Practice Address - Phone:304-267-0866
Practice Address - Fax:304-267-8348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV028075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001710137OtherBCBS-MT STATE
WV151474500OtherUS DEPT OF LABOR
WV2137778OtherMAMSI
MD9565OtherBCBS-CAREFIRST
WV3810005986Medicaid
MD0BGGSHOtherBCBS-CAREFIRST
WV1024916OtherBRICKSTREET
MD415580700Medicaid
WV8721526OtherCIGNA
WV224049OtherCARELINK
WV3810005986Medicaid
WV9314271Medicare PIN