Provider Demographics
NPI:1801828173
Name:GREENE, BRIAN RICHARD (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:RICHARD
Last Name:GREENE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-3116
Mailing Address - Country:US
Mailing Address - Phone:941-488-7050
Mailing Address - Fax:941-485-3574
Practice Address - Street 1:333 TAMIAMI TRL S
Practice Address - Street 2:SUITE 207
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2402
Practice Address - Country:US
Practice Address - Phone:941-484-2471
Practice Address - Fax:941-484-5487
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 1539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist