Provider Demographics
NPI:1609806462
Name:GREEN, BARBARA GORDON (PT, MS)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:GORDON
Last Name:GREEN
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 PROVIDENCE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2370
Mailing Address - Country:US
Mailing Address - Phone:704-377-0020
Mailing Address - Fax:
Practice Address - Street 1:725 PROVIDENCE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2370
Practice Address - Country:US
Practice Address - Phone:704-377-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist