Provider Demographics
NPI:1235292509
Name:GREENWOOD SPORTS AND INDUSTRIAL REHAB
Entity type:Organization
Organization Name:GREENWOOD SPORTS AND INDUSTRIAL REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:MCDONALD
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:BS IN RT
Authorized Official - Phone:864-229-9000
Mailing Address - Street 1:105 BROKEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-7920
Mailing Address - Country:US
Mailing Address - Phone:864-229-9580
Mailing Address - Fax:
Practice Address - Street 1:1602 SPRING ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4072
Practice Address - Country:US
Practice Address - Phone:864-229-9000
Practice Address - Fax:864-229-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1724261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy