NPIMap

Organization Active NPI

Mountaineer Physical Therapy & Sports Medicine

  • Physical Therapist
  • Summersville, WV
National Provider Identifier
1528047529
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MOUNTAINEER PHYSICAL THERAPY & SPORTS MEDICINE
Practice address
207 Merchants Walk
Summersville, WV 26651
Phone
(304) 872-7498
Fax
(304) 872-8144
NPI assigned
Jan 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

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

Authorized official

Name
Mr. Stephen Moss Young, PT, DPT, OCSNPI 1942280979
Title
President
Phone
(304) 872-7498

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

207 Merchants Walk
Summersville, WV 26651

Mailing address

PO Box 69
Summersville, WV 26651
Phone (304) 872-7498

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041104000070 WV Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1153383849 Receives reassigned benefits from 4 practitioners
Practice locations: Summersville, WV

National Provider Directory

National Provider Directory

Locations

207 Merchants Walk
Summersville, WV 26651
Phone (304) 872-7498

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747267200000",
    "number": "1528047529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "26651",
            "telephone_number": "304-872-7498",
            "fax_number": "304-872-8144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 MERCHANTS WALK",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "26651",
            "telephone_number": "304-872-7498",
            "fax_number": "304-872-8144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINEER PHYSICAL THERAPY & SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-10",
        "last_updated": "2025-05-15",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "MOSS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-872-7498",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, DPT, OCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Summersville, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; 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.