Provider Demographics
NPI:1417378878
Name:GREEN, CADEIDRA (MS, RKT)
Entity Type:Individual
Prefix:
First Name:CADEIDRA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, RKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 BRENNER AVE
Mailing Address - Street 2:BUILDING 7-ROOM 1011A
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2515
Mailing Address - Country:US
Mailing Address - Phone:704-638-9000
Mailing Address - Fax:704-638-3811
Practice Address - Street 1:1601 BRENNER AVE
Practice Address - Street 2:BUILDING 7-ROOM 1011A
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2515
Practice Address - Country:US
Practice Address - Phone:704-638-9000
Practice Address - Fax:704-638-3811
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Y00000X, 246W00000X
NC1909226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology