Healthcare Provider Details

I. General information

NPI: 1356902175
Provider Name (Legal Business Name): VIRGINIA ELIZABETH GREENE-HANNA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIRGINIA E GREENE LMT

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 7TH AVE SW STE B1
CEDAR RAPIDS IA
52404-2182
US

IV. Provider business mailing address

3850 COTTAGE GROVE AVE SE
CEDAR RAPIDS IA
52403-2125
US

V. Phone/Fax

Practice location:
  • Phone: 319-360-0645
  • Fax:
Mailing address:
  • Phone: 319-360-0645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number006699
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: