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47454 Route 52, Kermit, WV 25674-8052 | |
| (304) 393-4072 | |
| (304) 393-4074 |
| Full Name | |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 47454 Route 52, Kermit, West Virginia |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740467463 | NPI | - | NPPES |
| 002013370 | Other | WV | MOUNTAIN STATE BCBS |
| 3810011333 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | (* (Not Available)) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
414 Penco Rd, Weirton, WV 26062-3822 Ph: (304) 723-3780 | 47454 Route 52, Kermit, WV 25674-8052 Ph: (304) 393-4072 |
Dr. Larissa Stacy, PT, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 47454 Route 52, Kermit, WV 25674 Phone: 304-393-4072 Fax: 304-393-4074 | |
Mrs. Crystal Gail Krimm, MPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 47454 Route 52, Kermit, WV 25674 Phone: 304-393-4072 |