Provider Demographics
NPI:1285821033
Name:GREEN, KATHLEEN M (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:GREEN
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 1:2700 WYNFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WEST FRIENDSHIP
Mailing Address - State:MD
Mailing Address - Zip Code:21794-9519
Mailing Address - Country:US
Mailing Address - Phone:410-442-9959
Mailing Address - Fax:
Practice Address - Street 1:2700 WYNFIELD RD
Practice Address - Street 2:
Practice Address - City:WEST FRIENDSHIP
Practice Address - State:MD
Practice Address - Zip Code:21794-9519
Practice Address - Country:US
Practice Address - Phone:410-442-9959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist