Performance Physical Therapy and Rehabilitation
Organization Active NPI Physical Therapy Clinic/Center · Daniels, WV
NPI 1457716359 · NPPES record last updated Dec 18, 2015
Key facts
- NPI
- 1457716359
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- License
- 1641 (WV)
- Legal business name
- PERFORMANCE PHYSICAL THERAPY AND REHABILITATION
- Practice address
- 1338 Ritter Dr.
Daniels, WV 25832 - Phone
- (304) 890-3480
- NPI assigned
- Dec 18, 2015
- Organization subpart
- No
Authorized official
- Name
- Mrs. Angela G Beaver, MPT
- Title
- Owner
- Phone
- (304) 763-5121
Practitioners 5
-
Angela G Beaver, MPT
-
Jocelyn Bond, MA PT
-
Heather Dawn Gragg, MPT
-
George Rusty Nelson, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160517000643 | WV | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 4183927221 |
Receives reassigned benefits from 5 practitioners Practice locations: Daniels, WV |
National Provider Directory
Locations
1338 Ritter Dr
Daniels, WV 25832
Phone (304) 237-5585
2286 Ritter Dr
Daniels, WV 25832
Phone (304) 237-5585
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | 1641 | WV | Yes |
Addresses
Primary practice location
1338 Ritter Dr.
Daniels, WV 25832
Mailing address
204 Greenbrier Rd
Daniels, WV 25832-9703
Phone (304) 763-5121
Other providers in Daniels, WV
- Lily Payton Myles
- Amanda Leigh Neal
- Kera Nunn
- James Pack
- Angela Marie Pendleton
- Suzette Peterson
- Prompt Care Plus, MC
- Raleigh Center Opco, LLC
- Raliegh Manor Limited Partnership
- Michael Richmond Jr.
All providers in Daniels, WV · Physical Therapy Clinic/Center 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 Dec 18, 2015. 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.