Provider Demographics
NPI:1043651136
Name:GREENE, ARIEL MARGAURITE (ATC)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:MARGAURITE
Last Name:GREENE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1393 BIG WOODS STARKS RD
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70668-5205
Mailing Address - Country:US
Mailing Address - Phone:337-853-2329
Mailing Address - Fax:
Practice Address - Street 1:1747 IMPERIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5362
Practice Address - Country:US
Practice Address - Phone:337-721-7236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.2002612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer