Provider Demographics
NPI:1275978959
Name:GREENE, GLORIA DENISE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:DENISE
Last Name:GREENE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MRS
Other - First Name:GLORIA
Other - Middle Name:DENISE
Other - Last Name:WILLIAMS-GREENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:5485 NEW POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-7308
Mailing Address - Country:US
Mailing Address - Phone:901-834-0001
Mailing Address - Fax:
Practice Address - Street 1:721 W BROOKHAVEN CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4503
Practice Address - Country:US
Practice Address - Phone:901-821-0945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2259261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy