Organization
GREENBRIER VALLEY PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA STREETER (VICE PRESIDENT)
(800) 699-9395
Entity
Organization
Contact information
Practice address
3942 DAVIS STUART RD STE 3, RONCEVERTE, WV 24970-0269
(304) 647-3987
(304) 647-3990
Mailing address
PO BOX 932184, ATLANTA, GA 31193-4912
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810004589
—
WV
01
—
=========
WV WORKERS COMP
WV
Enumeration date
10/13/2006
Last updated
11/18/2023
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