Therapy Providers Service Organization, LLC

Organization Active NPI Physical Therapist · Kermit, WV

NPI 1740467463 · NPPES record last updated Apr 22, 2014

Key facts

NPI
1740467463
Entity type
Organization (NPI type 2)
Primary specialty
Physical Therapist 225100000X
Legal business name
THERAPY PROVIDERS SERVICE ORGANIZATION, LLC
Practice address
47454 Route 52
Kermit, WV 25674-8052
Phone
(304) 393-4072
Fax
(304) 393-4074
NPI assigned
Jan 24, 2008
Organization subpart
No

Authorized official

Name
Mark W Mascio
Title
President
Phone
(304) 723-3780

National Provider Directory

Locations

47454 Route 52
Kermit, WV 25674
Phone (304) 393-4072

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist
Group: 193400000X SINGLE SPECIALTY GROUP
225100000X Yes

Addresses

Primary practice location

47454 Route 52
Kermit, WV 25674-8052

Mailing address

414 Penco Rd
Weirton, WV 26062-3822
Phone (304) 723-3780

Other identifiers

IdentifierTypeStateIssuer
002013370OtherWVMOUNTAIN STATE BCBS
3810011333MedicaidWV

Other names

  • Brookeview Physical Therapy Doing business as

Other providers in Kermit, WV

All providers in Kermit, WV · Physical Therapist in West Virginia

Sources for this page

Verify at the official NPI Registry.