Provider Demographics
NPI:1710169388
Name:GREEN, CATHERINE RENEE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:RENEE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6927 W 101ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1640
Mailing Address - Country:US
Mailing Address - Phone:913-383-2536
Mailing Address - Fax:
Practice Address - Street 1:9120 W 75TH ST
Practice Address - Street 2:LIFE DYNAMICS BUILDING-SPORTSCARE
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2210
Practice Address - Country:US
Practice Address - Phone:913-676-7538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist