Provider Demographics
NPI:1194891846
Name:ORTHOPAEDIC CENTER OF THE VIRGINIAS PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:ORTHOPAEDIC CENTER OF THE VIRGINIAS PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRES
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PERSINGER LOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:PT OCS
Authorized Official - Phone:304-425-9857
Mailing Address - Street 1:311 COURTHOUSE RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2421
Mailing Address - Country:US
Mailing Address - Phone:304-425-9857
Mailing Address - Fax:304-487-3152
Practice Address - Street 1:311 COURTHOUSE RD
Practice Address - Street 2:SUITE #3
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2421
Practice Address - Country:US
Practice Address - Phone:304-425-9857
Practice Address - Fax:304-487-3152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
072404OtherANTHEM
1405075OtherUMWA
4502834OtherAETNA
WV0156090000Medicaid
151508800OtherUS DEPT OF LABOR
WV001721163OtherBCBS
270675OtherMAMSI
WV0156090000Medicaid