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General NPI Number Information
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NPI Number | 1255391975
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Entity Type | Individual
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Provider Name | JULIE LYNNE GREEN MSPT, OCS
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Gender | Female
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Dates
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Enumeration Date | 03/25/2006
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Last Update Date | 10/03/2019
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Provider Practice Location Address
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Address Line | 525 S 4TH ST STE 255
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City | PHILADELPHIA
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State | PA
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Zip | 19147-1573
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Country | US
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Telephone | 215-715-1367
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Fax | 267-507-9121
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Provider Business Mailing Address
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Address Line | 2 W REDMAN AVE
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City | HADDONFIELD
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State | NJ
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Zip | 08033-2317
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Country | US
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Telephone | 215-715-1367
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Fax | 267-507-9121
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT011280L
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License Number State | PA
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