Provider Demographics
NPI:1669457859
Name:GREENVILLE PROAXIS THERAPY, LLC
Entity Type:Organization
Organization Name:GREENVILLE PROAXIS THERAPY, LLC
Other - Org Name:ATI PHYSICAL THERAPY OF GREENVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-296-2222
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:103 N MAIN ST
Practice Address - Street 2:STE 99
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2796
Practice Address - Country:US
Practice Address - Phone:864-528-5728
Practice Address - Fax:864-528-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4143Medicaid
SCDD4407OtherMEDICARE RAILROAD
SCDD4407OtherMEDICARE RAILROAD
SCGP4275Medicaid
SC607756100OtherDEPT LABOR - GROVE
SC607756101OtherDEPT LABOR - PATEWOOD
SC607756102OtherDEPT LABOR - SIMPSONVILLE
SCGP4143Medicaid
SC8293Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
SCGP4394Medicaid