Provider Demographics
NPI:1932462769
Name:GREENE, KATHLEEN M (RPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:GREENE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2B LEE RD
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:CT
Mailing Address - Zip Code:06351-3042
Mailing Address - Country:US
Mailing Address - Phone:860-376-2564
Mailing Address - Fax:860-376-4812
Practice Address - Street 1:121 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1052
Practice Address - Country:US
Practice Address - Phone:860-537-6798
Practice Address - Fax:860-537-5926
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist