Provider Demographics
NPI:1992006456
Name:GREENE, CHERYL ANN (PTA-PHYSICAL THERAPI)
Entity Type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:ANN
Last Name:GREENE
Suffix:
Gender:F
Credentials:PTA-PHYSICAL THERAPI
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:DEPUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA-PHYSICAL THERAPI
Mailing Address - Street 1:PO BOX 923 LIBERTY , NY 12754
Mailing Address - Street 2:29 SCHOOLHOUSE ROAD, LIVINGTON MANOR NY 12758
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754
Mailing Address - Country:US
Mailing Address - Phone:845-439-1182
Mailing Address - Fax:845-439-1115
Practice Address - Street 1:29 SCHOOLHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754
Practice Address - Country:US
Practice Address - Phone:845-439-1182
Practice Address - Fax:845-439-1115
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002719-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant