Provider Demographics
NPI:1821399395
Name:GREENE, BRANDI SALENA (DPT)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:SALENA
Last Name:GREENE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 HARDWARE DR NE
Mailing Address - Street 2:BLDG C SUITE 4
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2017
Mailing Address - Country:US
Mailing Address - Phone:505-884-4609
Mailing Address - Fax:505-884-4015
Practice Address - Street 1:4811 HARDWARE DR NE
Practice Address - Street 2:BLDG C SUITE 4
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2017
Practice Address - Country:US
Practice Address - Phone:505-884-4609
Practice Address - Fax:505-884-4015
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLIF3903NM225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist