# COMMUNITY REHAB OF GREENVILLE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PIONEER SPORTS MEDICINE & PHYSICAL THERAPY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801984810
- **Authorized official:** MS. MELANIE L FAYARD P.T. (VICE PRESIDENT)
- **Authorized official phone:** (228) 436-0999

## Contact information

- **Practice address:** 3808 S LINDBERGH BLVD, SUITE 105, SAINT LOUIS, MO 63127-1367
- **Practice address phone:** (314) 843-7800
- **Practice address fax:** (314) 843-7804
- **Mailing address:** PO BOX 7066, GULFPORT, MS 39506-7066
- **Mailing address phone:** (228) 436-0999
- **Mailing address fax:** (228) 436-0990

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 261QP2000X | Physical Therapy Clinic/Center | NONE REQUIRED | MO | Yes |

## Other

- **Enumeration date:** 10/11/2006
- **Last updated:** 07/02/2008