MEDICARE: LATOYA L GREEN DPT

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	PT3861	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	446645	OTHER	TN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3133295	OTHER	TN	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902331093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYA L GREEN DPT

Provider Business Mailing Address
First Line	:	920 MADISON AVE STE 415
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38103-3469
Country	:	US
Telephone Number	:	901-448-5888
Fax Number	:	901-448-1411

Provider Business Practice Location Address
First Line	:	920 MADISON AVE SUITE 415
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38163-1614
Country	:	US
Telephone Number	:	901-448-5888
Fax Number	:	901-448-1411

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

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	10/13/2021

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Directions to “ LATOYA L GREEN DPT” Practice Location

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