Provider Demographics
NPI:1831192970
Name:GREENE REHAB SERVICES PA
Entity type:Organization
Organization Name:GREENE REHAB SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:941-484-2471
Mailing Address - Street 1:333 S. TAMIAMI TRL
Mailing Address - Street 2:SUITE 207
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2424
Mailing Address - Country:US
Mailing Address - Phone:941-484-2471
Mailing Address - Fax:941-484-5487
Practice Address - Street 1:333 S. TAMIAMI TRL
Practice Address - Street 2:SUITE 207
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2424
Practice Address - Country:US
Practice Address - Phone:941-484-2471
Practice Address - Fax:941-484-5487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880244100Medicaid
FLQW6OtherBLUE CROSS BLUE SHIELD
FLN8882OtherRAILROAD MEDICARE
FLHOR75OtherBLUE CROSS BLUE SHIELD
FLR75OtherBLUE CROSS BLUESHIELD
FLHOR75OtherBLUE CROSS BLUE SHIELD