Provider Demographics
NPI:1548360860
Name:RANKIN, KELLEY SCOTT (MPT)
Entity type:Individual
Prefix:MR
First Name:KELLEY
Middle Name:SCOTT
Last Name:RANKIN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5724 HAMMONDS MILL ROAD
Mailing Address - Street 2:SUITE G
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404
Mailing Address - Country:US
Mailing Address - Phone:304-274-0123
Mailing Address - Fax:304-274-1819
Practice Address - Street 1:5724 HAMMONDS MILL RD
Practice Address - Street 2:SUITE G
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-6465
Practice Address - Country:US
Practice Address - Phone:304-274-0123
Practice Address - Fax:304-274-1819
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT 001719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV650020891OtherRAILROAD PROVIDER #
WV9420213001Medicaid
WV650020891OtherRAILROAD PROVIDER #
WVRA4043353Medicare PIN