Provider Demographics
NPI:1801298146
Name:GREEN, ALLISON (DPT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 JAMAICAWAY
Mailing Address - Street 2:APT 2
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2026
Mailing Address - Country:US
Mailing Address - Phone:203-410-1051
Mailing Address - Fax:
Practice Address - Street 1:480 JAMAICAWAY
Practice Address - Street 2:APT 2
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2026
Practice Address - Country:US
Practice Address - Phone:203-410-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist