Provider Demographics
NPI:1376800748
Name:GREEN APPLE REHAB LLC
Entity Type:Organization
Organization Name:GREEN APPLE REHAB LLC
Other - Org Name:GREEN APPLE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:UTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-550-5058
Mailing Address - Street 1:150 WILLOW CREEK DR
Mailing Address - Street 2:STE 105
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76085-3652
Mailing Address - Country:US
Mailing Address - Phone:817-550-5058
Mailing Address - Fax:817-550-8177
Practice Address - Street 1:150 WILLOW CREEK DR
Practice Address - Street 2:STE 105
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76085-3652
Practice Address - Country:US
Practice Address - Phone:817-550-5058
Practice Address - Fax:817-550-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation