Basic Information
| Provider Information | |||||||||
| NPI: | 1639774383 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNTAIN RIVER PHYSICAL THERAPY SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 36TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261011005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3049173660 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5479 POTTSVILLE PIKE STE 200 | ||||||||
| Address2: | |||||||||
| City: | LEESPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 195338634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109266778 | ||||||||
| FaxNumber: | 6109267200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2020 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| AuthorizedOfficialLastName: | REED | ||||||||
| AuthorizedOfficialFirstName: | BURTON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3049173660 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.