Provider Demographics
NPI:1205106846
Name:GREENE, WILLIAM A (BS LMT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:GREENE
Suffix:
Gender:F
Credentials:BS LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 ELMWOOD AVE
Mailing Address - Street 2:12 CORNERS BRIGHTON
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2210
Mailing Address - Country:US
Mailing Address - Phone:585-943-0722
Mailing Address - Fax:
Practice Address - Street 1:154 PEARL ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2914
Practice Address - Country:US
Practice Address - Phone:585-993-5368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0222591225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist