Active NPI
Michael Brent Conaway, PT
- Physical Therapist
- Moundsville, WV
National Provider Identifier
1104996073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 790
- Practice address
- 100 Teletech Drive
Suite 100
Moundsville, WV 26041 - Phone
- (304) 843-3379
- Fax
- (304) 221-3013
- NPI assigned
- Nov 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 790 | WV | Primary |
Addresses
Primary practice location
100 Teletech Drive
Suite 100
Moundsville, WV 26041
Mailing address
100 Teletech Drive
Suite 100
Moundsville, WV 26041
Phone (304) 843-3379
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810008493 | Medicaid | WV | |
| 2675154 | Medicaid | OH | |
| P00476589 | Other | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medical Rehabilitative Services | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Wheeling, WV
- NPI 1043437692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669075200000",
"number": "1104996073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 TELETECH DRIVE",
"address_2": "SUITE 100",
"city": "MOUNDSVILLE",
"state": "WV",
"postal_code": "26041",
"telephone_number": "304-843-3379",
"fax_number": "304-221-3013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 TELETECH DRIVE",
"address_2": "SUITE 100",
"city": "MOUNDSVILLE",
"state": "WV",
"postal_code": "26041",
"telephone_number": "304-843-3379",
"fax_number": "304-221-3013"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONAWAY",
"first_name": "MICHAEL",
"middle_name": "BRENT",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-08",
"last_updated": "2022-11-22",
"certification_date": "2022-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "790",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810008493",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2675154",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00476589",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Moundsville, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.