Healthcare Provider Details

I. General information

NPI: 1235836347
Provider Name (Legal Business Name): HALEY ERIN GREEN PT, DPT, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 02/09/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E ARLINGTON BLVD
GREENVILLE NC
27858-2785
US

IV. Provider business mailing address

8131 BENAJA RD
REIDSVILLE NC
27320
US

V. Phone/Fax

Practice location:
  • Phone: 252-565-8812
  • Fax:
Mailing address:
  • Phone: 336-327-7851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP21996
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: