Provider Demographics
NPI:1649455221
Name:GREENE, MANYA S (MHS, PT)
Entity type:Individual
Prefix:
First Name:MANYA
Middle Name:S
Last Name:GREENE
Suffix:
Gender:F
Credentials:MHS, PT
Other - Prefix:
Other - First Name:MANYA
Other - Middle Name:S
Other - Last Name:HOUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS, PT
Mailing Address - Street 1:PO BOX 292340
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-0340
Mailing Address - Country:US
Mailing Address - Phone:704-477-2959
Mailing Address - Fax:
Practice Address - Street 1:3122 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4004
Practice Address - Country:US
Practice Address - Phone:937-299-9337
Practice Address - Fax:937-299-9227
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93592251P0200X
OH012772225100000X, 2251G0304X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2367282Medicaid
OH2367282Medicaid