Provider Demographics
NPI:1467803221
Name:GREEN, CHAYA S (DPT)
Entity Type:Individual
Prefix:
First Name:CHAYA
Middle Name:S
Last Name:GREEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8402 CENTENNIAL PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4793
Mailing Address - Country:US
Mailing Address - Phone:702-294-7499
Mailing Address - Fax:702-294-7494
Practice Address - Street 1:4370 BLUE DIAMOND RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7787
Practice Address - Country:US
Practice Address - Phone:702-443-9301
Practice Address - Fax:702-342-0600
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.022522225100000X
NV4726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist