Basic Information
| Provider Information | |||||||||
| NPI: | 1235292509 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENWOOD SPORTS AND INDUSTRIAL REHAB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 BROKEN RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296467920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642299580 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1602 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296464072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642299000 | ||||||||
| FaxNumber: | 8642295474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PETTIT | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
| AuthorizedOfficialMiddleName: | MCDONALD | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8642299000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | B.S. IN R.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 1724 | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.