MEDICARE: ELIZABETH GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5311	ME

General Provider Information

NPI Number	:	1689033524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH GREEN

Provider Business Mailing Address
First Line	:	8 SCIENCE PARK RD
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-6112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 SCIENCE PARK RD
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-6112
Country	:	US
Telephone Number	:	207-761-8402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2016
Last Update Date	:	01/05/2022

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Directions to “ ELIZABETH GREEN ” Practice Location

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