Organization Name: | LAKESIDE PHYSICAL THERAPY & FITNESS CENTER, LLC |
NPI Number: | 1427092287 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JANE MARIA NICOLI (PT/OWNER) |
Mailing Address: | 2195 Cheat Rd Suite 1 Morgantown |
State: | WV US |
Postal Code: | 265084451 |
Phone Number: | 3045942500 |
Fax Number: | 3045949310 |
NPI Enumeration Date: | 06/15/2006 |
NPI Last Update Date: | 12/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 001103 |
Healthcare Provider Taxonomy: (Secondary) | N |
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 |