Organization
FOUNDATION PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL COLLINS JACKSON DPT (OWNER/PROVIDER)
(864) 380-8946
Entity
Organization
Contact information
Practice address
12 WAITE ST STE B1, GREENVILLE, SC 29607-3226
(864) 380-8946
Mailing address
12 WAITE ST STE B, GREENVILLE, SC 29607-3200
(864) 203-3048
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
10/10/2022
Last updated
07/16/2024
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