Organization
FAYETTEVILLE PHYSICAL THERAPY & SPORTS REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN M BRANDSTETTER (OFFICE MANAGER)
(304) 574-1416
Entity
Organization
Contact information
Practice address
233 N COURT ST, FAYETTEVILLE, WV 25840-1233
(304) 574-1416
(304) 574-1474
Mailing address
233 N COURT ST, FAYETTEVILLE, WV 25840-1233
(304) 574-1416
(304) 574-1474
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
WV902
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0156959000
—
WV
01
—
1459717
UMWA
WV
Enumeration date
11/01/2006
Last updated
01/08/2008
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