Basic Information
| Provider Information | |||||||||
| NPI: | 1538552732 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENVILLE PROAXIS THERAPY LLC | ||||||||
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| OtherOrganizationName: | PROAXIS THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 N MAIN ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296012796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645285700 | ||||||||
| FaxNumber: | 8645285701 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 DOCTORS DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296054265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647977320 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2015 | ||||||||
| LastUpdateDate: | 03/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | MCENROE | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8645285707 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.