Healthcare Provider Details

I. General information

NPI: 1821399395
Provider Name (Legal Business Name): BRANDI SALENA GREENE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 HARDWARE DR NE BLDG C SUITE 4
ALBUQUERQUE NM
87109-2017
US

IV. Provider business mailing address

4811 HARDWARE DR NE BLDG C SUITE 4
ALBUQUERQUE NM
87109-2017
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-4609
  • Fax: 505-884-4015
Mailing address:
  • Phone: 505-884-4609
  • Fax: 505-884-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLIF3903NM
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: