Provider Demographics
NPI:1639282007
Name:GREEN, RACHEL E (MS, ATC)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:E
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PENNSYLVANIA PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-2301
Mailing Address - Country:US
Mailing Address - Phone:318-208-5112
Mailing Address - Fax:317-817-1220
Practice Address - Street 1:201 PENNSYLVANIA PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2301
Practice Address - Country:US
Practice Address - Phone:318-208-5112
Practice Address - Fax:317-817-1220
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0013182255A2300X
IN36001750A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer