Basic Information
| Provider Information | |||||||||
| NPI: | 1184160400 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENVILLE PROAXIS THERAPY LLC | ||||||||
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| OtherOrganizationName: | ATI PHYSICAL THERAPY OF GREENVILLE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962223 | ||||||||
| FaxNumber: | 6307599510 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 VILLAGE CENTER BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295796706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432495616 | ||||||||
| FaxNumber: | 8432491843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2017 | ||||||||
| LastUpdateDate: | 01/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | MCGIVERN | ||||||||
| AuthorizedOfficialFirstName: | LYNN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF COMPLIANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6302962222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.