Organization
GRAND RIVER PHYSICAL THERAPY & SPORTS MEDICINE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES HENRY GREENE III MS, PT, ATC (PRESIDENT)
(660) 726-5762
Entity
Organization
Contact information
Practice address
203 S POLK ST, ALBANY, MO 64402-1618
(660) 726-5762
(660) 726-5764
Mailing address
203 S POLK ST, ALBANY, MO 64402-1618
(660) 726-5762
(660) 726-5764
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
104902
MO
2251S0007X
Sports Physical Therapist
104902
MO
2255A2300X
Athletic Trainer
Primary
106862
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001794500
COMMUNITY HL PLAN PROV #
MO
01
—
35391014
BC/BS GROUP BILLING NUMBE
MO
Enumeration date
06/09/2006
Last updated
09/11/2025
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