Provider Demographics
NPI:1649243346
Name:GREEN, JULIE A (DPT, CBIS)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:GREEN
Suffix:
Gender:F
Credentials:DPT, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7441 HIGHPOINT CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46259-7667
Mailing Address - Country:US
Mailing Address - Phone:317-518-6265
Mailing Address - Fax:
Practice Address - Street 1:7711 SHELBY ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5986
Practice Address - Country:US
Practice Address - Phone:317-378-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-12
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 390200000X
IN36000788A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer