Gomer Go, | |
203 Covington Way, Vienna, WV 26105-8096 | |
(740) 371-0610 | |
Not Available |
Full Name | Gomer Go |
---|---|
Gender | Male |
Speciality | Physical Therapist |
Location | 203 Covington Way, Vienna, West Virginia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1386201507 | NPI | - | NPPES |
F903373 | Other | WV | DRIVER'S LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | (* (Not Available)) | Primary |
Provider Name | Lutheran Haven Therapy Llc |
---|---|
Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1033969902 PECOS PAC ID: 8729521026 Enrollment ID: O20240614001582 |
Mailing Address | Practice Location Address |
---|---|
Gomer Go, 2600 Compass Rd, Glenview, IL 60026-8001 Ph: () - | Gomer Go, 203 Covington Way, Vienna, WV 26105-8096 Ph: (740) 371-0610 |
Markus Brunzel, Physical Therapist Medicare: Medicare Enrolled Practice Location: 1500 Grand Central Ave Ste 101, Vienna, WV 26105 Phone: 304-693-2781 | |
Brittany Lynne Vass, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1605 Grand Central Ave, Vienna, WV 26105 Phone: 304-295-7290 Fax: 304-295-5922 | |
Andrew Robinson, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1500 Grand Central Ave, Suite 101, Vienna, WV 26105 Phone: 304-295-3060 Fax: 304-295-3065 | |
Ashley Casto, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1500 Grand Central Ave Ste 101, Vienna, WV 26105 Phone: 304-693-2781 | |
Mr. Chad Copeland, MPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1158 46th St, Vienna, WV 26105 Phone: 304-295-3131 Fax: 304-295-0700 | |
Joseph Alan Trout, PT, DPT, MS, CSCS Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1500 Grand Central Ave Ste 101, Vienna, WV 26105 Phone: 304-295-3060 | |
Ms. Diana Theresia Benton, MPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1500 Grand Central Ave, Suite 101, Vienna, WV 26105 Phone: 304-295-3060 |