Organization Name: | PERFORMANCE PHYSICAL THERAPY AND REHABILITATION |
NPI Number: | 1457716359 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANGELA G BEAVER (OWNER) |
Mailing Address: | 1338 Ritter Dr. Daniels |
State: | WV US |
Postal Code: | 25832 |
Phone Number: | 3048903480 |
Fax Number: | |
NPI Enumeration Date: | 12/18/2015 |
NPI Last Update Date: | 12/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | 1641 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |