Organization
PREMIER REHABILITATION SYSTEMS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY RYDBOM PTA (CORPORATE OFFICER)
(724) 379-6412
Entity
Organization
Contact information
Practice address
1008 TAVERN RD, MARTINSBURG, WV 25401-2801
(304) 264-4040
(304) 264-4041
Mailing address
4660 STATE ROUTE 51, SUITE 2, BELLE VERNON, PA 15012-4305
(724) 379-6412
(412) 592-0939
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001756986
MOUNTAIN STATE BC/BS
WV
01
—
0207724000
WEST VIRGINIA MEDICAID
WV
01
—
1568199
HIGHMARK BC/BS
PA
01
—
600828800
DOL MARTINSBURG
WV
01
—
600828801
DOL WINCHESTER
VA
01
—
600828802
DOL MCMURRAY
PA
01
—
600828803
DOL MORGANTOWN
WV
Enumeration date
10/27/2006
Last updated
10/14/2016
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