Provider Demographics
NPI:1033729397
Name:GREENE, KATHLEEN O'NEILL (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:O'NEILL
Last Name:GREENE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 JEFFREY DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-2323
Mailing Address - Country:US
Mailing Address - Phone:423-718-2690
Mailing Address - Fax:
Practice Address - Street 1:500 WALTON WAY
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3418
Practice Address - Country:US
Practice Address - Phone:470-306-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0065682251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics