Provider Demographics
NPI:1992982276
Name:GREENVILLE PHYSICAL THERAPY AND ASSOCIATES, INC
Entity type:Organization
Organization Name:GREENVILLE PHYSICAL THERAPY AND ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:WESTON
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:252-714-3344
Mailing Address - Street 1:PO BOX 4065
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27836-2065
Mailing Address - Country:US
Mailing Address - Phone:252-714-3344
Mailing Address - Fax:
Practice Address - Street 1:2430 CHARLES BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5924
Practice Address - Country:US
Practice Address - Phone:252-714-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty