Provider Demographics
NPI:1396011276
Name:GREENE, AMY E (LMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:GREENE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 E 16TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-8925
Mailing Address - Country:US
Mailing Address - Phone:208-660-3138
Mailing Address - Fax:
Practice Address - Street 1:3900 E 16TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-8925
Practice Address - Country:US
Practice Address - Phone:208-660-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID11-0158174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist