NPIMap

Organization Active NPI

Professional Sportscare & Rehab of West Virginia, LLC

  • Physical Therapist
  • Shepherdstown, WV
National Provider Identifier
1780134353
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PROFESSIONAL SPORTSCARE & REHAB OF WEST VIRGINIA, LLC
Practice address
39 Maddex Dr
Ste 2
Shepherdstown, WV 25443-4322
Phone
(304) 876-8600
NPI assigned
Oct 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Authorized official

Name
Tasheda Broughton, PESC
Title
Manager, Credentialing
Phone
(252) 248-3313

Specialties & licenses 1

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

Addresses

Primary practice location

39 Maddex Dr
Ste 2
Shepherdstown, WV 25443-4322

Mailing address

2122 York Rd Ste 302
Oak Brook, IL 60523-1930
Phone (410) 927-8768

Other names 1

  • PIVOT PHYSICAL THERAPY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pivot Physical Therapy8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2122 York Rd
Ste 302
Oak Brook, IL 60523

NPI Registry JSON

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

{
    "created_epoch": "1475798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730419200000",
    "number": "1780134353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 302",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231930",
            "telephone_number": "410-927-8768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 MADDEX DR",
            "address_2": "STE 2",
            "city": "SHEPHERDSTOWN",
            "state": "WV",
            "postal_code": "254434322",
            "telephone_number": "304-876-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL SPORTSCARE & REHAB OF WEST VIRGINIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-07",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A",
        "authorized_official_last_name": "BROUGHTON",
        "authorized_official_first_name": "TASHEDA",
        "authorized_official_title_or_position": "MANAGER, CREDENTIALING",
        "authorized_official_telephone_number": "252-248-3313",
        "authorized_official_credential": "PESC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PIVOT PHYSICAL THERAPY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shepherdstown, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2024; 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.