Organization
PROFESSIONAL SPORTSCARE & REHAB OF WEST VIRGINIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TASHEDA BROUGHTON PESC (MANAGER, CREDENTIALING)
(252) 248-3313
Entity
Organization
Contact information
Practice address
207 S PRINCESS ST STE 3AND4, SHEPHERDSTOWN, WV 25443-1581
(304) 876-8600
(304) 876-8601
Mailing address
2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
(252) 248-3133
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 002689
WV
Other
Enumeration date
04/21/2009
Last updated
11/01/2024
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