Basic Information
| Provider Information | |||||||||
| NPI: | 1730809864 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GREENBRIER VALLEY PHYSICAL THERAPY LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ACTIVE FITNESS AND PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 932184 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 311932184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006999395 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 436 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | OAK HILL | ||||||||
| State: | WV | ||||||||
| PostalCode: | 259013009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044653654 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2022 | ||||||||
| LastUpdateDate: | 09/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | STREETER | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9049444063 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 261QR0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.