Provider Demographics
NPI:1558366773
Name:GREENE, JUDY A (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:A
Last Name:GREENE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 S VIRGINIA ST
Mailing Address - Street 2:STE 108
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-6008
Mailing Address - Country:US
Mailing Address - Phone:270-885-9110
Mailing Address - Fax:270-885-9110
Practice Address - Street 1:1910 S VIRGINIA ST
Practice Address - Street 2:STE 108
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-6008
Practice Address - Country:US
Practice Address - Phone:270-885-9110
Practice Address - Fax:270-885-9110
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000050162OtherANTHEM PROVIDER NUMBER
KY87015673Medicaid
KY5016901Medicare ID - Type UnspecifiedPROVIDER NUMBER