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General NPI Number Information
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NPI Number | 1992982276
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Entity Type | Organization
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Legal Business Name | GREENVILLE PHYSICAL THERAPY AND ASSOCIATES, INC
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 2430 CHARLES BLVD
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City | GREENVILLE
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State | NC
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Zip | 27858-5924
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Country | US
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Telephone | 252-714-5060
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4065
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City | GREENVILLE
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State | NC
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Zip | 27836-2065
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Country | US
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Telephone | 252-714-3344
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SHERRIE WESTON ODOM
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Credential | P.T.
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Telephone | 252-714-3344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3398
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License Number State | NC
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