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General NPI Number Information
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NPI Number | 1093891145
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Entity Type | Individual
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Provider Name | KRISTEN M GREEN PA, RPT
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 46200 POTOMAC RUN PLZ
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City | STERLING
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State | VA
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Zip | 20164-6622
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Country | US
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Telephone | 571-313-5087
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Fax |
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Provider Business Mailing Address
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Address Line | 43950 HARBOR HILLS TER UNIT 202
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City | LEESBURG
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State | VA
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Zip | 20176-3441
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Country | US
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Telephone | 518-353-6120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 007860-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 007860-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 005277
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110-008276
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License Number State | VA
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