NPIMap

Organization Active NPI

Greenbrier Valley Physical Therapy, LLC

  • Physical Therapist
  • Greenbank, WV
National Provider Identifier
1104476001
Registry record updated Nov 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
GREENBRIER VALLEY PHYSICAL THERAPY, LLC
Practice address
4914 Potomac Highlands Trail
Greenbank, WV 24944
Phone
(681) 206-7107
Fax
(681) 206-7108
NPI assigned
Sep 13, 2019
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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

4914 Potomac Highlands Trail
Greenbank, WV 24944

Mailing address

PO Box 932184
Atlanta, GA 31193-4912

Other names 1

  • Seneca Trail Physical Therapy-North 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 2

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": "1568332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700265600000",
    "number": "1104476001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 932184",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311934912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4914 POTOMAC HIGHLANDS TRAIL",
            "city": "GREENBANK",
            "state": "WV",
            "postal_code": "24944",
            "telephone_number": "681-206-7107",
            "fax_number": "681-206-7108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENBRIER VALLEY PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-13",
        "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": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seneca Trail Physical Therapy-North",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Seneca Trail Physical Therapy-North",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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.