Provider Demographics
NPI:1508964461
Name:GREEN, CATHERINE GRACE (MPT)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:GRACE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TUC RD
Mailing Address - Street 2:3A
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5086
Mailing Address - Country:US
Mailing Address - Phone:301-602-0145
Mailing Address - Fax:
Practice Address - Street 1:7 TUC RD
Practice Address - Street 2:3A
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5086
Practice Address - Country:US
Practice Address - Phone:301-602-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52865902OtherFEDERAL BC/BS
DC47610157OtherFEDERA; BC/BS
MD2128319OtherMAMSI PROVIDER
DC47610157OtherFEDERA; BC/BS