Provider Demographics
NPI:1528201605
Name:GREENAWALT, NAOMI ESTHER
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:ESTHER
Last Name:GREENAWALT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COLORADO BLVD
Mailing Address - Street 2:318
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4084
Mailing Address - Country:US
Mailing Address - Phone:866-801-9492
Mailing Address - Fax:
Practice Address - Street 1:700 COLORADO BLVD
Practice Address - Street 2:318
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4084
Practice Address - Country:US
Practice Address - Phone:866-801-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist