Healthcare Provider Details

I. General information

NPI: 1609541721
Provider Name (Legal Business Name): GREENBRIER VALLEY PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 11/18/2023
Certification Date: 11/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 BUD RIDGE RD
UNION WV
24983-9517
US

IV. Provider business mailing address

PO BOX 932184
ATLANTA GA
31193-2184
US

V. Phone/Fax

Practice location:
  • Phone: 304-772-5639
  • Fax: 304-772-4639
Mailing address:
  • Phone: 800-699-9395
  • Fax: 904-757-9679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMANDA STREETER
Title or Position: VICE PRESIDENT
Credential:
Phone: 8-699-9395