Provider Demographics
NPI:1427420892
Name:EMBODY ORTHOPEDIC & SPORTS PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:EMBODY ORTHOPEDIC & SPORTS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:APRIL
Authorized Official - Last Name:MCKEON POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MED
Authorized Official - Phone:864-729-1319
Mailing Address - Street 1:1440 PELHAM RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3900
Mailing Address - Country:US
Mailing Address - Phone:864-729-1319
Mailing Address - Fax:864-729-3726
Practice Address - Street 1:1440 PELHAM RD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3900
Practice Address - Country:US
Practice Address - Phone:864-729-1319
Practice Address - Fax:864-729-3726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty