Provider Demographics
NPI:1255005963
Name:GREENFIELD PT COMP LLC
Entity type:Organization
Organization Name:GREENFIELD PT COMP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MPT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-635-3979
Mailing Address - Street 1:112 ASH ST
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-1487
Mailing Address - Country:US
Mailing Address - Phone:715-635-3979
Mailing Address - Fax:715-635-3990
Practice Address - Street 1:N4439 FOREST CREEK DR
Practice Address - Street 2:
Practice Address - City:SHELL LAKE
Practice Address - State:WI
Practice Address - Zip Code:54871-7620
Practice Address - Country:US
Practice Address - Phone:715-635-3979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty