Provider Demographics
NPI:1114149978
Name:GREENE, MICHELLE SUZANNE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SUZANNE
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 1:4100 SE ADAMS RD
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-8437
Mailing Address - Country:US
Mailing Address - Phone:918-331-9922
Mailing Address - Fax:918-331-9971
Practice Address - Street 1:4100 SE ADAMS RD
Practice Address - Street 2:SUITE A-100
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8437
Practice Address - Country:US
Practice Address - Phone:641-754-6120
Practice Address - Fax:918-331-9971
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03294225100000X
OK2790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist