Provider Demographics
NPI:1619119617
Name:GREEN, ERIN (MPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
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:PO BOX 470607
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94147-0607
Mailing Address - Country:US
Mailing Address - Phone:415-561-6655
Mailing Address - Fax:415-561-6650
Practice Address - Street 1:1162B GORGAS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94129-1406
Practice Address - Country:US
Practice Address - Phone:415-561-6655
Practice Address - Fax:415-561-6650
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
BV123VMedicare PIN