Provider Demographics
NPI:1043215866
Name:MOUNTAIN PHYSICAL THERAPY SERVICES INC
Entity type:Organization
Organization Name:MOUNTAIN PHYSICAL THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-254-3525
Mailing Address - Street 1:90 SOUTHSIDE AVE
Mailing Address - Street 2:STE 225
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4188
Mailing Address - Country:US
Mailing Address - Phone:828-254-3525
Mailing Address - Fax:828-254-0792
Practice Address - Street 1:90 SOUTHSIDE AVE
Practice Address - Street 2:STE 225
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4188
Practice Address - Country:US
Practice Address - Phone:828-254-3525
Practice Address - Fax:828-254-0792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2010-07-28
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
NC0796KOtherBLUE CROSS BLUE SHEILD
NC2502601Medicare ID - Type Unspecified