Provider Demographics
NPI:1730865163
Name:VORHOLT, STEPHEN DOUGLAS (PT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:VORHOLT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 STILL WATER RUN
Mailing Address - Street 2:
Mailing Address - City:POCA
Mailing Address - State:WV
Mailing Address - Zip Code:25159-8976
Mailing Address - Country:US
Mailing Address - Phone:304-389-2619
Mailing Address - Fax:
Practice Address - Street 1:4825 MACCORKLE AVE SW STE F
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1365
Practice Address - Country:US
Practice Address - Phone:304-346-9667
Practice Address - Fax:304-346-9717
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist