Provider Demographics
NPI:1366494890
Name:GREEN, PATRICIA S (PT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:S
Last Name:GREEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:SHREVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8663 MIDDLEBROOK PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-1612
Mailing Address - Country:US
Mailing Address - Phone:865-801-9380
Mailing Address - Fax:865-381-0707
Practice Address - Street 1:8663 MIDDLEBROOK PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-1612
Practice Address - Country:US
Practice Address - Phone:865-801-9380
Practice Address - Fax:865-381-0707
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN82995OtherBLUE CROSS
TNCH4394OtherMEDICARE-RAILROAD GROUP ID
TN3652725Medicaid
TN3652725Medicaid