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Organization

MOUNTAIN STATE HOME REHAB, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARY JANE BANIAK PT (OWNER)
(301) 707-3346
Entity
Organization

Contact information

Practice address
RR 5 BOX 521, KEYSER, WV 26726-9016
(301) 707-3346
(304) 726-4213
Mailing address
RR 5 BOX 521, KEYSER, WV 26726-9016
(301) 707-3346
(304) 726-4213

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1589
WV

Other

Enumeration date
03/08/2007
Last updated
08/22/2020
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