Healthcare Provider Details

I. General information

NPI: 1275978959
Provider Name (Legal Business Name): GLORIA DENISE GREENE PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GLORIA DENISE WILLIAMS-GREENE PHYSICAL THERAPIST

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W BROOKHAVEN CIR
MEMPHIS TN
38117-4503
US

IV. Provider business mailing address

5485 NEW POINTE DR
SOUTHAVEN MS
38672-7308
US

V. Phone/Fax

Practice location:
  • Phone: 901-821-0945
  • Fax:
Mailing address:
  • Phone: 901-834-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2259
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: