Riverside Physical Therapy, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

2160 Issued in WV

Legal business name

RIVERSIDE PHYSICAL THERAPY, LLC

Practice address

105 Seasons LN
Mineral Wells, WV 26150-8110

Phone

(304) 615-7576

Fax

(304) 422-4094

NPI assigned

Jan 24, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Joshua Bradford Gandee, MPT

Title

Owner/Manager/Therapist

Phone

(304) 615-7576

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1327363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328745600000",
    "number": "1174894026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 SEASONS LN",
            "city": "MINERAL WELLS",
            "state": "WV",
            "postal_code": "261508110",
            "telephone_number": "304-615-7576",
            "fax_number": "304-422-4094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 SEASONS LN",
            "city": "MINERAL WELLS",
            "state": "WV",
            "postal_code": "261508110",
            "telephone_number": "304-615-7576",
            "fax_number": "304-422-4094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-24",
        "last_updated": "2012-02-09",
        "status": "A",
        "authorized_official_last_name": "GANDEE",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "BRADFORD",
        "authorized_official_title_or_position": "OWNER/MANAGER/THERAPIST",
        "authorized_official_telephone_number": "304-615-7576",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WV",
            "license": "2160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joyce Elaine Persinger
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• Finbar Gerard Powderly, M. D.
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• Lisa Marie Rutter
• Amber Ryan
• Andrew Robert Sells, DPT

• Physical Therapy Clinic/Center in Mineral Wells, WV
• Providers in Mineral Wells, WV by specialty
• Physical Therapy Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.