NPIMap

Organization Active NPI

Preston Rehabilitation & Orthopedic Physical Therapy, Inc

  • Physical Therapist
  • Kingwood, WV
National Provider Identifier
1497700918
Registry record updated Nov 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
013138 Issued in WV
Legal business name
PRESTON REHABILITATION & ORTHOPEDIC PHYSICAL THERAPY, INC
Practice address
421 Morgantown St
Kingwood, WV 26537-1095
Phone
(304) 329-3739
Fax
(304) 329-3250
NPI assigned
May 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2012

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

Authorized official

Name
Mr. Glen Walton McNew III, MBA
Title
Business Manager
Phone
(304) 329-3739

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 013138 WV Primary

Addresses

Primary practice location

421 Morgantown St
Kingwood, WV 26537-1095

Mailing address

421 Morgantown St
Kingwood, WV 26537-1095
Phone (304) 329-3739

Other identifiers 1

IdentifierTypeStateIssuer
0204035000MedicaidWV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040305000058 WV Part B Supplier - Clinic/Group Practice 6002704798 Receives reassigned benefits from 6 practitioners
Practice locations: Kingwood, WV

National Provider Directory

National Provider Directory

Locations

421 Morgantown St
Kingwood, WV 26537
Phone (304) 329-3739

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353974400000",
    "number": "1497700918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 MORGANTOWN ST",
            "city": "KINGWOOD",
            "state": "WV",
            "postal_code": "265371095",
            "telephone_number": "304-329-3739",
            "fax_number": "304-329-3250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 MORGANTOWN ST",
            "city": "KINGWOOD",
            "state": "WV",
            "postal_code": "265371095",
            "telephone_number": "304-329-3739",
            "fax_number": "304-329-3250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTON REHABILITATION & ORTHOPEDIC PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2012-11-27",
        "status": "A",
        "authorized_official_last_name": "MCNEW",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "WALTON",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "304-329-3739",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WV",
            "license": "013138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0204035000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingwood, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; 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.