Provider Demographics
NPI:1013288091
Name:GREENE, LISA HARTLEY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:HARTLEY
Last Name:GREENE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 GENE HARTLEY RD
Mailing Address - Street 2:
Mailing Address - City:BOOMER
Mailing Address - State:NC
Mailing Address - Zip Code:28606-8198
Mailing Address - Country:US
Mailing Address - Phone:336-927-3396
Mailing Address - Fax:
Practice Address - Street 1:333 E LEE AVE
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8132
Practice Address - Country:US
Practice Address - Phone:336-927-3396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2928225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant