Provider Demographics
NPI:1356464374
Name:GREENE, DANITA ANNE (LPTA)
Entity Type:Individual
Prefix:
First Name:DANITA
Middle Name:ANNE
Last Name:GREENE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 ZIRCON CT
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-8726
Mailing Address - Country:US
Mailing Address - Phone:410-219-1157
Mailing Address - Fax:
Practice Address - Street 1:WICOMICO NURSING HOME
Practice Address - Street 2:900 BOOTH ST
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2378
Practice Address - Country:US
Practice Address - Phone:410-742-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1771225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant