Organization
GREENVILLE PEAK PERFORMANCE SPORTS & PHYSICAL THERAPY, LLC
Active
Organization
GREENVILLE PEAK PERFORMANCE SPORTS & PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH LAURENT (AUTHORIZED OFFICIAL)
(616) 356-5011
Entity
Organization
Contact information
Practice address
740 W FIRE TOWER RD, SUITE 113, WINTERVILLE, NC 28590-8411
(252) 636-9800
(252) 636-1945
Mailing address
607 DEWEY AVE NW, SUITE 300, GRAND RAPIDS, MI 49504-7335
(616) 356-5000
(616) 356-5001
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019E8
BCBSNC
NC
05
—
7200527
—
NC
Enumeration date
05/31/2007
Last updated
04/30/2018
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