Mountain Ridge Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

2714 Issued in WV

Legal business name

MOUNTAIN RIDGE PHYSICAL THERAPY LLC

Practice address

6000 Coombs Farm Drive
Suite 202B
Morgantown, WV 26508

Phone

(304) 685-6064

NPI assigned

Feb 6, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Derek D Clark, DPT, PT, MS, CSCS

Title

Owner, Physical Therapist

Phone

(304) 685-6064

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1486339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486339200000",
    "number": "1457899809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 COOMBS FARM DRIVE",
            "address_2": "SUITE 202B",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "26508",
            "telephone_number": "304-685-6064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 COOMBS FARM DRIVE",
            "address_2": "SUITE 202B",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "26508",
            "telephone_number": "304-685-6064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN RIDGE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-06",
        "last_updated": "2017-02-06",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER, PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "304-685-6064",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT, PT, MS, CSCS"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WV",
            "license": "2714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alvin H Moss, M. D.
• Aron Moss
• Hailey Cameron Mostacciuolo, M.A., PLPC, NCC
• Mariah Mott, MD
• Mountain Laurel Wellness LLC
• Mountain State Mobility
• Mountain State Sleep Center, Inc
• Mountain State Spinal Care
• Mountain State Wellness, PLLC
• Mountain Valley LLC

• Physical Therapy Clinic/Center in Morgantown, WV
• Providers in Morgantown, 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 6, 2017; 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.