Organization
PROFESSIONAL SPORTSCARE & REHAB OF WEST VIRGINIA, LLC
Active
Other names
PIVOT PHYSICAL THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
TASHEDA BROUGHTON PESC (MANAGER, CREDENTIALING)
(252) 248-3313
Entity
Organization
Contact information
Practice address
39 MADDEX DR, STE 2, SHEPHERDSTOWN, WV 25443-4322
(304) 876-8600
Mailing address
2122 YORK RD STE 302, OAK BROOK, IL 60523-1930
(410) 927-8768
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
10/07/2016
Last updated
11/01/2024
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