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General NPI Number Information
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NPI Number | 1235292509
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Entity Type | Organization
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Legal Business Name | GREENWOOD SPORTS AND INDUSTRIAL REHAB
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1602 SPRING ST
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City | GREENWOOD
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State | SC
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Zip | 29646-4072
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Country | US
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Telephone | 864-229-9000
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Fax | 864-229-5474
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Provider Business Mailing Address
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Address Line | 105 BROKEN RIDGE DR
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City | GREENWOOD
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State | SC
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Zip | 29646-7920
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Country | US
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Telephone | 864-229-9580
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. LAURIE MCDONALD PETTIT
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Credential | B.S. IN R.T.
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Telephone | 864-229-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1724
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License Number State | SC
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