# FOUNDATION PHYSICAL THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124743331
- **Authorized official:** SAMUEL COLLINS JACKSON DPT (OWNER/PROVIDER)
- **Authorized official phone:** (864) 380-8946

## Contact information

- **Practice address:** 104 MAULDIN RD STE B, GREENVILLE, SC 29605-1221
- **Practice address phone:** (864) 214-6680
- **Practice address fax:** (864) 309-8043
- **Mailing address:** 104 MAULDIN RD STE B, GREENVILLE, SC 29605-1221
- **Mailing address phone:** (864) 214-6680
- **Mailing address fax:** (864) 309-8043

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/10/2022
- **Last updated:** 06/02/2026