Individual
ELIZABETH H PETRY-JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
140 EXECUTIVE DR, GREER, SC 29651-1200
(864) 848-6339
(864) 848-7203
Mailing address
1361 W WADE HAMPTON BLVD STE F, PMB 207, GREER, SC 29650-1146
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5036
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
943423122
INSURANCE PROVIDER NUMBER
SC
01
—
P00263714
MEDICARE RAILROAD NUMBER
SC
Enumeration date
07/27/2006
Last updated
07/18/2014
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