Fayetteville Physical Therapy & Sports Rehabilitation

Primary specialty

SpecialistTaxonomy code 174400000X

License

WV902 Issued in WV

Legal business name

FAYETTEVILLE PHYSICAL THERAPY & SPORTS REHABILITATION

Practice address

233 N Court St
Fayetteville, WV 25840-1233

Phone

(304) 574-1416

Fax

(304) 574-1474

NPI assigned

Nov 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Karen M Brandstetter

Title

Office Manager

Phone

(304) 574-1416

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Isabel K Bosso, DPT

  • Physical Therapist
  • Mount Pleasant, SC
  • NPI 1902232580

  WV

  Medicare reassignment NPD
• Lisa E Harris, P.T.

  • Physical Therapist
  • Fayetteville, WV
  • NPI 1235314378
  Medicare reassignment
• Mark Pugeda, DPT

  • Physical Therapist
  • Lexington, KY
  • NPI 1033535158
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199750400000",
    "number": "1003994054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 N COURT ST",
            "city": "FAYETTEVILLE",
            "state": "WV",
            "postal_code": "258401233",
            "telephone_number": "304-574-1416",
            "fax_number": "304-574-1474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 N COURT ST",
            "city": "FAYETTEVILLE",
            "state": "WV",
            "postal_code": "258401233",
            "telephone_number": "304-574-1416",
            "fax_number": "304-574-1474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE PHYSICAL THERAPY & SPORTS REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-01-08",
        "status": "A",
        "authorized_official_last_name": "BRANDSTETTER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "304-574-1416",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "WV",
            "license": "WV902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0156959000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "1459717",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fayette County Board of Education
• Fayette County Board of Education
• Fayette County Board of Health
• Fayette Medical Services PLLC (Fayetteville Urgent Care)
• Fayette Nursing & Rehabilitation Center LLC
• Fayetteville SNF LLC (Fayetteville Rehabilitation and Healthcare Center)
• Anna Fernandez
• Christy Fernandez
• Five Oaks Family Clinic, Inc.
• Foot and Ankle Clinic of the Virginias Inc

• Specialist in Fayetteville, WV
• Providers in Fayetteville, WV by specialty
• Specialist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.