Healthcare Provider Details

I. General information

NPI: 1003645375
Provider Name (Legal Business Name): GREENBRIER VALLEY PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 B ST STE A
SAINT ALBANS WV
25177-2727
US

IV. Provider business mailing address

PO BOX 932184
ATLANTA GA
31193-2184
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-7293
  • Fax:
Mailing address:
  • Phone:
  • 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: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 800-699-9395