Healthcare Provider Details

I. General information

NPI: 1811729445
Provider Name (Legal Business Name): KATHRYN MARIE GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 IRVING ST NW
WASHINGTON DC
20010-2921
US

IV. Provider business mailing address

1301 20TH ST NW APT 404
WASHINGTON DC
20036-6037
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-1566
  • Fax:
Mailing address:
  • Phone: 847-271-1809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT210002468
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: