Healthcare Provider Details

I. General information

NPI: 1649455221
Provider Name (Legal Business Name): MANYA S GREENE MHS, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANYA S HOUK MHS, PT

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3122 WILMINGTON PIKE
KETTERING OH
45429-4004
US

IV. Provider business mailing address

PO BOX 292340
KETTERING OH
45429-0340
US

V. Phone/Fax

Practice location:
  • Phone: 937-299-9337
  • Fax: 937-299-9227
Mailing address:
  • Phone: 704-477-2959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number9359
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012772
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number012772
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number012772
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: