Provider Demographics
NPI:1730727090
Name:IMPACT PHYSICAL THERAPY AND REHABILITATION
Entity type:Organization
Organization Name:IMPACT PHYSICAL THERAPY AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:845-820-2295
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19543-0416
Mailing Address - Country:US
Mailing Address - Phone:610-286-0004
Mailing Address - Fax:610-601-3616
Practice Address - Street 1:3200 MAIN ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:PA
Practice Address - Zip Code:19543-7700
Practice Address - Country:US
Practice Address - Phone:610-286-0004
Practice Address - Fax:610-601-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy