Basic Information
| Provider Information | |||||||||
| NPI: | 1346347804 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THERAPY SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6000 HAMPTON CENTER SUITE B | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045991500 | ||||||||
| FaxNumber: | 3045997800 | ||||||||
| Practice Location | |||||||||
| Address1: | 6000 HAMPTON CENTER SUITE B | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045991500 | ||||||||
| FaxNumber: | 3045997800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2006 | ||||||||
| LastUpdateDate: | 12/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | FORD | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNTING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 3045991500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 4005078-000 | 05 | WV | MEDICAID |