Provider Demographics
NPI:1467583237
Name:GREENE, LORI LYN (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LYN
Last Name:GREENE
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12738 HASKINS ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2474
Mailing Address - Country:US
Mailing Address - Phone:913-829-2790
Mailing Address - Fax:
Practice Address - Street 1:6400 GLENWOOD ST
Practice Address - Street 2:SUITE 205
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-4016
Practice Address - Country:US
Practice Address - Phone:913-432-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-027522251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics