Professional Sportscare & Rehab of West Virginia, LLC
NPI #1407301518 in Charles Town, West Virginia
Provider Information
- NPI Number
- 1407301518
- Entity Type
- Organization
- Organization Name
- Professional Sportscare & Rehab of West Virginia, LLC
- Primary Specialty
- Physical Therapist
- Enumeration Date
- Aug 18, 2016
- Last Updated
- Nov 1, 2024
Practice Location
- Address
- 46 TRIFECTA PL
- Address 2
- STE 104
- City
- Charles Town
- State
- West Virginia
- ZIP Code
- 25414-5652
- Phone
- (304) 728-9087
Authorized Official
- Name
- TASHEDA BROUGHTON, PESC
- Title
- MANAGER, CREDENTIALING
- Phone
- (252) 248-3313
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physical Therapist |
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