NPIMap

Organization Active NPI

Foundation Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Greenville, SC
National Provider Identifier
1124743331
Registry record updated Jun 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
FOUNDATION PHYSICAL THERAPY, LLC
Practice address
104 Mauldin Rd Ste B
Greenville, SC 29605-1221
Phone
(864) 214-6680
Fax
(864) 309-8043
NPI assigned
Oct 10, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2026

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

Authorized official

Name
Samuel Collins Jackson, DPTNPI 1811511199
Title
Owner/Provider
Phone
(864) 380-8946

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

104 Mauldin Rd Ste B
Greenville, SC 29605-1221

Mailing address

104 Mauldin Rd Ste B
Greenville, SC 29605-1221
Phone (864) 214-6680

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230130000319 SC Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5597136507 Receives reassigned benefits from 6 practitioners
Practice locations: Greenville, SC

National Provider Directory

National Provider Directory

Locations

12 Waite St
Ste B
Greenville, SC 29607

12 Waite St
Greenville, SC 29607

12 Waite St
Ste B1
Greenville, SC 29607
Phone (864) 214-6680

104 Mauldin Rd
Ste B
Greenville, SC 29605
Phone (864) 214-6680

Practitioners & affiliated clinicians

Practitioners 9

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": "1665360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780358400000",
    "number": "1124743331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 MAULDIN RD STE B",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296051221",
            "telephone_number": "864-214-6680",
            "fax_number": "864-309-8043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MAULDIN RD STE B",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296051221",
            "telephone_number": "864-214-6680",
            "fax_number": "864-309-8043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNDATION PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-10",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "COLLINS",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "864-380-8946",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; 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.