Provider Demographics
NPI:1225156334
Name:SPORTS THERAPY OF GREENVILLE, LLC
Entity Type:Organization
Organization Name:SPORTS THERAPY OF GREENVILLE, LLC
Other - Org Name:D1 SPORTS THERAPY OF GREENVILLE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-342-0214
Mailing Address - Street 1:PO BOX 331225
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-7512
Mailing Address - Country:US
Mailing Address - Phone:615-342-0223
Mailing Address - Fax:
Practice Address - Street 1:1334 MILLER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5710
Practice Address - Country:US
Practice Address - Phone:864-288-3878
Practice Address - Fax:864-288-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherTAX ID