Provider Demographics
NPI:1083796908
Name:GREEN COFFEY, PATRICIA LEN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LEN
Last Name:GREEN COFFEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 COMMERCE 382 OLD NORTHERNER RD
Mailing Address - Street 2:
Mailing Address - City:DEKALB JCT
Mailing Address - State:NY
Mailing Address - Zip Code:13630
Mailing Address - Country:US
Mailing Address - Phone:315-287-7886
Mailing Address - Fax:315-287-7886
Practice Address - Street 1:342 OLD DEKALB RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617
Practice Address - Country:US
Practice Address - Phone:315-386-2647
Practice Address - Fax:315-386-4071
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0044671225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant