MEDICARE: GREENWOOD OSTEOPRACTIC PHYSICAL THERAPY AND EDUCATIONAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1154283174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWOOD OSTEOPRACTIC PHYSICAL THERAPY AND EDUCATIONAL SERVICES

Provider Business Mailing Address
First Line	:	6458 E SKINNER RD
Second Line	:
City	:	STILLMAN VALLEY
State	:	IL
Zip	:	61084-9224
Country	:	US
Telephone Number	:	815-222-3629
Fax Number	:

Provider Business Practice Location Address
First Line	:	3490 COLONY BAY DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61109-2560
Country	:	US
Telephone Number	:	815-691-2708
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MATTHEW WAYNE GREENWOOD
Credential	:
Telephone Number	:	815-222-3629

Provider Enumeration Date	:	11/28/2025
Last Update Date	:	11/28/2025

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