| Organization Name: | MOUNTAIN STATE HOME REHAB, INC. |
| NPI Number: | 1063543585 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY JANE BANIAK (OWNER) |
| Mailing Address: | Rr 5 Box 521 Keyser |
| State: | WV US |
| Postal Code: | 267269016 |
| Phone Number: | 3017073346 |
| Fax Number: | 3047264213 |
| NPI Enumeration Date: | 03/08/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1589 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |