Provider Demographics
NPI:1356902175
Name:GREENE-HANNA, VIRGINIA ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ELIZABETH
Last Name:GREENE-HANNA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:E
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:3850 COTTAGE GROVE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2125
Mailing Address - Country:US
Mailing Address - Phone:319-360-0645
Mailing Address - Fax:
Practice Address - Street 1:42 7TH AVE SW STE B1
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-2182
Practice Address - Country:US
Practice Address - Phone:319-360-0645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006699225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA006699OtherSTATE OF IOWA LICENSING BOARD