NPIMap

Organization Active NPI

Mountain River Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Ellenboro, WV
National Provider Identifier
1164438487
Registry record updated May 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
MOUNTAIN RIVER PHYSICAL THERAPY LLC
Practice address
117 W. Wagner Street
Ellenboro, WV 26346
Phone
(304) 869-3888
Fax
(304) 869-3444
NPI assigned
Jul 31, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Burton R Reed, PT, OCS, FAAOMPT
Title
Owner/PT
Phone
(304) 865-6778

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 19

Practitioners 3

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20040507000524 WV Part B Supplier - Clinic/Group Practice 0547259335 Receives reassigned benefits from 19 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ripley, WV; Williamstown, WV; Wheeling, WV; Wellsburg, WV; Vienna, WV; Ravenswood, WV; Point Pleasant, WV; Parkersburg, WV…

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X WV Primary

Addresses

NPPES NPI Registry

Primary practice location

117 W. Wagner Street
Ellenboro, WV 26346

Mailing address

415 36TH St
Suite 100
Parkersburg, WV 26101-1005
Phone (304) 917-3660

Other identifiers 3

NPPES NPI Registry
IdentifierTypeStateIssuer
2701786MedicaidOH
DA4403OtherMEDICARE ID TYPE UNSPEC
3810006084MedicaidWV

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 27, 2016.

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464307200000",
    "number": "1164438487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 36TH ST",
            "address_2": "SUITE 100",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261011005",
            "telephone_number": "304-917-3660",
            "fax_number": "304-917-3674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 W. WAGNER STREET",
            "city": "ELLENBORO",
            "state": "WV",
            "postal_code": "26346",
            "telephone_number": "304-869-3888",
            "fax_number": "304-869-3444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN RIVER PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2016-05-27",
        "status": "A",
        "authorized_official_last_name": "REED",
        "authorized_official_first_name": "BURTON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/PT",
        "authorized_official_telephone_number": "304-865-6778",
        "authorized_official_credential": "PT, OCS, FAAOMPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2701786",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID TYPE UNSPEC",
            "identifier": "DA4403",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810006084",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellenboro, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2016; 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.