Individual provider Active NPI

Kimberly Rena Stevens, PT

  • Physical Therapist
  • Greenville, SC
National Provider Identifier
1720094618
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4278 Issued in SC
Practice address
200 Patewood Dr
Ste C150
Greenville, SC 29615-3593
Phone
(864) 454-0904
NPI assigned
Jul 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 4278 SC Primary

Addresses

Primary practice location

200 Patewood Dr
Ste C150
Greenville, SC 29615-3593

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Other identifiers 1

IdentifierTypeStateIssuer
TH1406MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100629000154 SC Practitioner - Physical Therapist in Private Practice 9931230398 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greenville Proaxis Therapy LLCGroup PAC ID 0244267771, 221 clinicians
Excel Rehabilitation and SportsGroup PAC ID 1759481559, 53 clinicians

Practice addresses (Care Compare)

103 N Main St
Suite 201
Greenville, SC 29601-2756
Phone (864) 528-5753

77 Pointe Cir
Greenville, SC 29615-3505
Phone (864) 233-4477

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Excel Rehabilitation and Sports Physical Therapist CurrentSince Nov 10, 2025 Accepting new patients
Prisma Health University Medical Group Past Accepting new patients
Accelerated Physical Therapy PA Past Accepting new patients
Excel Rehabilitation and Sports Physical Therapist Past Accepting new patients

Locations

77 Pointe Cir
Greenville, SC 29615
Phone (864) 233-4477

300 N Main St
Greer, SC 29650
Phone (864) 230-9996

877 NE Main St
Ste B
Simpsonville, SC 29681
Phone (864) 233-4477

6717C State Park Rd
Travelers Rest, SC 29690
Phone (864) 610-9641

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1720094618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR",
            "address_2": "STE C150",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153593",
            "telephone_number": "864-454-0904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "KIMBERLY",
        "middle_name": "RENA",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "4278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TH1406",
            "state": "SC"
        }
    ],
    "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 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.