Provider Demographics
NPI:1346384948
Name:GREENE, KATIE M (MS, ATC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:GREENE
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-4303
Mailing Address - Country:US
Mailing Address - Phone:570-660-1286
Mailing Address - Fax:
Practice Address - Street 1:1 COLLEGE AVE
Practice Address - Street 2:DIF 38
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5778
Practice Address - Country:US
Practice Address - Phone:570-320-2400
Practice Address - Fax:570-329-4959
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0039212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer