Provider Demographics
NPI:1982317731
Name:GREEN, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12206 E COUNTY ROAD 101
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-4990
Mailing Address - Country:US
Mailing Address - Phone:432-813-4326
Mailing Address - Fax:
Practice Address - Street 1:12206 E COUNTY ROAD 101
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-4990
Practice Address - Country:US
Practice Address - Phone:432-813-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist