Provider Demographics
NPI:1033188396
Name:JVB PHYSICAL THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:JVB PHYSICAL THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFAYE
Authorized Official - Middle Name:VERDINA
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS, NCS
Authorized Official - Phone:843-364-5089
Mailing Address - Street 1:1635 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5816
Mailing Address - Country:US
Mailing Address - Phone:843-364-5089
Mailing Address - Fax:843-763-0229
Practice Address - Street 1:1635 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5816
Practice Address - Country:US
Practice Address - Phone:843-364-5089
Practice Address - Fax:843-763-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27232251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4092Medicaid
SC=========OtherBLUE CROSS BLUE SHIELD
SC8228Medicare PIN