Brady Andrew Ernst, PT, DPT
Individual provider Active NPI Physical Therapist · Jane Lew, WV
NPI 1154093698 · NPPES record last updated Sep 6, 2022
Key facts
- NPI
- 1154093698
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT004554 (WV)
- Practice address
- 174 Industrial Park Rd
Jane Lew, WV 26378-9785 - Phone
- (048) 848-2373
- Fax
- (304) 884-8924
- NPI assigned
- Oct 4, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221102001195 | WV | Practitioner - Physical Therapist in Private Practice | 6103214150 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT029802 | PA | MD | Physical Therapist |
| PT004554 | WV | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain River Physical Therapy Specialists LLC | Physical Therapist | Current |
Accepting new patients |
| Mountain River Physical Therapy Specialists LLC | Physical Therapist | Current |
Accepting new patients |
| Mountain River Physical Therapy LLC | Physical Therapist | Past | Accepting new patients |
Locations
1650 Lyndon Farm Ct
Ste 300
Louisville, KY 40223
Phone (726) 202-3039
174 Industrial Park Rd
Jane Lew, WV 26378
Phone (304) 269-0613
1212 Garfield Ave
Ste 200
Parkersburg, WV 26101
Phone (304) 865-2778
415 36th St
Ste 100
Parkersburg, WV 26101
Phone (304) 917-3660
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | |||
| Physical Therapist | 225100000X | PT029802 | PA | |
| Physical Therapist | 225100000X | PT004554 | WV | Yes |
Addresses
Primary practice location
174 Industrial Park Rd
Jane Lew, WV 26378-9785
Mailing address
1650 Lyndon Farm CT Ste 300
Louisville, KY 40223-5005
Phone (304) 917-3660
Other providers in Jane Lew, WV
- Brittany Michelle Davisson
- Dayal Pate Company
- Joy Dean
- Jaryn Dodrill
- Dr. Brian Hornsby, PLLC
- Family Medical Clinic of Jane Lew
- Family Medical Clinic of Jane Lew ( Lab)
- Family Medical Clinic of Jane Lew (Epsdt)
- Family Medical Clinic of Jane Lew (Lab)
- Lora J Fitzgerald
All providers in Jane Lew, WV · Physical Therapist in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.