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General NPI Number Information
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NPI Number | 1528580099
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Entity Type | Individual
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Provider Name | PATRICIA LYNN GREEN PTA
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Gender | Female
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 07/17/2017
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Provider Practice Location Address
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Address Line | 118 MEDICAL DR
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City | CARMEL
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State | IN
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Zip | 46032-2923
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Country | US
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Telephone | 317-577-3103
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Fax | 317-200-3965
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Provider Business Mailing Address
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Address Line | 15226 GOODTIME CT
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City | CARMEL
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State | IN
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Zip | 46032-1037
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Country | US
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Telephone | 317-937-4317
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 060003159A
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License Number State | IN
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