Basic Information
Provider Information
NPI: 1649889924
EntityType: 2
ReplacementNPI:  
OrganizationName: MOUNTAIN RIVER PHYSICAL THERAPY, LLC
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Mailing Information
Address1: 415 36TH ST STE 100
Address2:  
City: PARKERSBURG
State: WV
PostalCode: 261011005
CountryCode: US
TelephoneNumber: 3049173660
FaxNumber: 3049173674
Practice Location
Address1: 174 INDUSTRIAL PARK RD
Address2:  
City: JANE LEW
State: WV
PostalCode: 263789785
CountryCode: US
TelephoneNumber: 3049173660
FaxNumber: 3049173674
Other Information
ProviderEnumerationDate: 07/23/2020
LastUpdateDate: 07/23/2020
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AuthorizedOfficialLastName: ROGERS
AuthorizedOfficialFirstName: KRISTA
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AuthorizedOfficialTitleorPosition: CFO AND VP OF FINANCE/OPERATIONS
AuthorizedOfficialTelephone: 3048656778
IsSoleProprietor:  
IsOrganizationSubpart: N
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NPICertificationDate: 07/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QP2000X  Y Ambulatory Health Care FacilitiesClinic/CenterPhysical Therapy

No ID Information.


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