NPIMap

Organization Active NPI

Professional Medical Rehabilitation Inc.

  • Physical Medicine & Rehabilitation Physician
  • Morgantown, WV
National Provider Identifier
1346434867
Registry record updated Jan 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
WV16960 Issued in WV
Legal business name
PROFESSIONAL MEDICAL REHABILITATION INC.
Practice address
460 Mylan Park LN
Morgantown, WV 26501-2281
Phone
(304) 983-7766
Fax
(304) 983-7768
NPI assigned
Aug 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2016

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

Authorized official

Name
Dr. J David Lynch Jr., M.D.
Title
Ceo
Phone
(304) 983-7766

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X WV16960 WV Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT002617 WV
Physical Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 225200000X PTA001299 WV
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X 1999 0357 WV

Addresses

Primary practice location

460 Mylan Park LN
Morgantown, WV 26501-2281

Mailing address

460 Mylan Park LN
Morgantown, WV 26501-2281
Phone (304) 983-7766

Other identifiers 4

IdentifierTypeStateIssuer
223202OtherWVCARELINK
001371360OtherWVMT STATE BCBS
3810007971MedicaidWV
000578387OtherWVHIGHMARK BLUESHIELD

National Provider Directory

National Provider Directory

Locations

360 Suncrest Town Centre Dr
Morgantown, WV 26505
Phone (304) 554-0516

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453852800000",
    "number": "1346434867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 MYLAN PARK LN",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265012281",
            "telephone_number": "304-983-7766",
            "fax_number": "304-983-7768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 MYLAN PARK LN",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265012281",
            "telephone_number": "304-983-7766",
            "fax_number": "304-983-7768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL MEDICAL REHABILITATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-28",
        "last_updated": "2016-01-27",
        "status": "A",
        "authorized_official_last_name": "LYNCH",
        "authorized_official_first_name": "J DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-983-7766",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WV",
            "license": "WV16960",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WV",
            "license": "PT002617",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "WV",
            "license": "PTA001299",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "WV",
            "license": "1999 0357",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARELINK",
            "identifier": "223202",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MT STATE BCBS",
            "identifier": "001371360",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810007971",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUESHIELD",
            "identifier": "000578387",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morgantown, WV

Sources for this page

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