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General NPI Number Information
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NPI Number | 1669427795
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Entity Type | Individual
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Provider Name | HEIDI ELLEN GREENE MPT
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Gender | Female
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 32 BROAD STREET RD TUCKAHOE PHYSICAL THERAPY CORP
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City | MANAKIN SABOT
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State | VA
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Zip | 23103-2213
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Country | US
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Telephone | 804-784-7090
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Fax | 804-784-7092
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Provider Business Mailing Address
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Address Line | 2415 IRISDALE AVE
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City | RICHMOND
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State | VA
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Zip | 23228
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Country | US
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Telephone | 804-264-3397
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305004914
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License Number State | VA
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