Healthcare Provider Details

I. General information

NPI: 1912428566
Provider Name (Legal Business Name): ELIZABETH GREEN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH PHELPS P.T.

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 02/28/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 GUNBARREL ROAD SUITE 101
CHATTANOOGA TN
37421
US

IV. Provider business mailing address

975 EAST THIRD ST. BOX 159
CHATTANOOGA TN
37403
US

V. Phone/Fax

Practice location:
  • Phone: 423-648-0698
  • Fax: 423-778-9875
Mailing address:
  • Phone: 423-778-3110
  • Fax: 423-778-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012874
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11821
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: