Provider Demographics
NPI:1760057400
Name:GREEN, DARBY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DARBY
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 N LOOP 1604 E STE 101
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2799
Mailing Address - Country:US
Mailing Address - Phone:210-590-4000
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:1324 E COMMON ST STE 307
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3566
Practice Address - Country:US
Practice Address - Phone:830-625-7310
Practice Address - Fax:830-625-3228
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1346195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist