Provider Demographics
NPI:1235203159
Name:OREILLY GREEN, ANNETTE N (DPT)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:N
Last Name:OREILLY GREEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:N
Other - Last Name:O'REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1020 CORN TASSEL TRL
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-5606
Mailing Address - Country:US
Mailing Address - Phone:276-666-4474
Mailing Address - Fax:
Practice Address - Street 1:3 STARLING AVE
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2921
Practice Address - Country:US
Practice Address - Phone:276-632-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist