Provider Demographics
NPI:1396267886
Name:TRI-STATE PHYSIATRY LLC
Entity type:Organization
Organization Name:TRI-STATE PHYSIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GIBBS-MCELVYQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-923-4028
Mailing Address - Street 1:1160 VAN VOORHIS RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3437
Mailing Address - Country:US
Mailing Address - Phone:304-598-1100
Mailing Address - Fax:304-598-1103
Practice Address - Street 1:1160 VAN VOORHIS RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3437
Practice Address - Country:US
Practice Address - Phone:304-598-1100
Practice Address - Fax:304-598-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty