Provider Demographics
NPI:1780812354
Name:GREENE, COLLEEN K (PT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:K
Last Name:GREENE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:A
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5212 GABLE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9306
Mailing Address - Country:US
Mailing Address - Phone:984-344-7506
Mailing Address - Fax:984-201-0215
Practice Address - Street 1:111 E VANCE ST STE A
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2264
Practice Address - Country:US
Practice Address - Phone:984-344-7506
Practice Address - Fax:984-201-0215
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist