Provider Demographics
NPI:1952694077
Name:MCCOMBS, PHILIP R (DPT)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:MCCOMBS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 GRAND PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4049
Mailing Address - Country:US
Mailing Address - Phone:304-834-3905
Mailing Address - Fax:304-917-4872
Practice Address - Street 1:417 GRAND PARK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26105-4049
Practice Address - Country:US
Practice Address - Phone:304-834-3905
Practice Address - Fax:304-917-4872
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist