Organization
GASSAWAY GLENVILLE PHYSICAL THERAPY SPECIALITS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN CHARLES BORING MPT (OWNER/PRESIDENT)
(304) 364-9191
Entity
Organization
Contact information
Practice address
155 RESTON PLACE, GASSAWAY, WV 26624
(304) 364-9191
(304) 364-9193
Mailing address
155 RESTON PLACE, GASSAWAY, WV 26624
(304) 364-9191
(304) 364-9193
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
001248
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001886362
BCBS
WV
01
—
1036377
WV WORKERS COMPENSATION
WV
Enumeration date
09/22/2006
Last updated
09/29/2015
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