Healthcare Provider Details

I. General information

NPI: 1649243346
Provider Name (Legal Business Name): JULIE A GREEN DPT, CBIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7711 SHELBY ST
INDIANAPOLIS IN
46227-5986
US

IV. Provider business mailing address

7441 HIGHPOINT CIR
INDIANAPOLIS IN
46259-7667
US

V. Phone/Fax

Practice location:
  • Phone: 317-378-7565
  • Fax:
Mailing address:
  • Phone: 317-518-6265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36000788A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: