Provider Demographics
NPI:1750313433
Name:GREENE, MONICA ROSE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:ROSE
Last Name:GREENE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:ROSE
Other - Last Name:BARRILLEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3840 HULEN ST
Mailing Address - Street 2:NORTH TOWER
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7277
Mailing Address - Country:US
Mailing Address - Phone:817-219-9978
Mailing Address - Fax:
Practice Address - Street 1:5650 N RIVERSIDE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-2464
Practice Address - Country:US
Practice Address - Phone:817-219-9978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1164248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81TT86OtherBCBS
TX189249902Medicaid