NPIMap

Organization Active NPI

Greenbrier Valley Physical Therapy, LLC

  • Physical Medicine & Rehabilitation Physician
  • Beckley, WV
National Provider Identifier
1104413756
Registry record updated Nov 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
GREENBRIER VALLEY PHYSICAL THERAPY, LLC
Practice address
514 Beckley Crossing SHPG Ctr
Beckley, WV 25801-7110
Phone
(304) 250-0428
Fax
(304) 252-0243
NPI assigned
Dec 29, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amanda Streeter
Title
Vice President
Phone
(800) 699-9395

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

514 Beckley Crossing SHPG Ctr
Beckley, WV 25801-7110

Mailing address

484 Riverside Ave
Jacksonville, FL 32202-4912
Phone (800) 699-9395

Other names 1

  • New River Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031209001137 WV Part B Supplier - Clinic/Group Practice 3870499957 Receives reassigned benefits from 62 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Victor, WV; Union, WV; St Albans, WV; Ronceverte, WV; Rainelle, WV; Princeton, WV; Pineville, WV; Peterstown, WV…

Other NPIs on the same Medicare enrollment 21

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 21

National Provider Directory

National Provider Directory
Tax ID family
Greenbrier Valley Physi26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700265600000",
    "number": "1104413756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "484 RIVERSIDE AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322024912",
            "telephone_number": "800-699-9395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 BECKLEY CROSSING SHPG CTR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258017110",
            "telephone_number": "304-250-0428",
            "fax_number": "304-252-0243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENBRIER VALLEY PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-29",
        "last_updated": "2023-11-18",
        "certification_date": "2023-11-18",
        "status": "A",
        "authorized_official_last_name": "STREETER",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "800-699-9395"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New River Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "New River Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beckley, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.