Healthcare Provider Details

I. General information

NPI: 1124118658
Provider Name (Legal Business Name): GREENBRIER VALLEY PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/18/2023
Certification Date: 11/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18228 SENECA TRAIL
MARLINTON WV
24954
US

IV. Provider business mailing address

484 RIVERSIDE AVE
JACKSONVILLE FL
32202-4912
US

V. Phone/Fax

Practice location:
  • Phone: 304-799-4500
  • Fax: 304-799-4501
Mailing address:
  • Phone: 800-699-9395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA STREETER
Title or Position: VICE PRESIDENT
Credential:
Phone: 800-699-9395