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General NPI Number Information
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NPI Number | 1487452587
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Entity Type | Individual
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Provider Name | MARQUITA KALITHIA GREEN LMT
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Gender | Female
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 1010 FOX CHASE RD
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City | ROCKLEDGE
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State | PA
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Zip | 19046-4124
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Country | US
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Telephone | 484-944-3139
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Fax |
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Provider Business Mailing Address
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Address Line | 707 KENILWORTH AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19126-3716
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Country | US
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Telephone | 215-444-5777
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MSG015922
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License Number State | PA
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