Provider Demographics
NPI:1255391975
Name:GREEN, JULIE LYNNE (MSPT, OCS)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LYNNE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2 W REDMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2317
Mailing Address - Country:US
Mailing Address - Phone:215-715-1367
Mailing Address - Fax:267-507-9121
Practice Address - Street 1:525 S 4TH ST STE 255
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1573
Practice Address - Country:US
Practice Address - Phone:215-715-1367
Practice Address - Fax:267-507-9121
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011280L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist