Provider Demographics
NPI:1407338155
Name:GREENE-ROGAN, MONICA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNN
Last Name:GREENE-ROGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-2851
Mailing Address - Country:US
Mailing Address - Phone:830-895-3200
Mailing Address - Fax:
Practice Address - Street 1:1400 HILLTOP RD
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-2851
Practice Address - Country:US
Practice Address - Phone:830-895-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1044568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist