Organization
THERAPY PROVIDERS SERVICE ORGANIZATION, LLC
Active
Other names
Brookeview Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MARK W MASCIO (PRESIDENT)
(304) 723-3780
Entity
Organization
Contact information
Practice address
47454 ROUTE 52, KERMIT, WV 25674-8052
(304) 393-4072
(304) 393-4074
Mailing address
414 PENCO RD, WEIRTON, WV 26062-3822
(304) 723-3780
(304) 723-4110
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002013370
MOUNTAIN STATE BCBS
WV
05
—
3810011333
—
WV
Enumeration date
01/24/2008
Last updated
04/22/2014
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