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General NPI Number Information
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NPI Number | 1922352418
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Entity Type | Organization
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Legal Business Name | GREEN THERAPY PLLC
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 8801 SUMMIT RIDGE DR
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City | LOUISVILLE
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State | KY
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Zip | 40241-1390
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Country | US
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Telephone | 502-836-3027
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Fax | 888-366-7472
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Provider Business Mailing Address
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Address Line | 8801 SUMMIT RIDGE DR
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City | LOUISVILLE
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State | KY
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Zip | 40241-1390
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Country | US
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Telephone | 502-836-3027
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Fax | 888-366-7472
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. ELIZABETH ANN GREEN
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Credential | PT
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Telephone | 502-836-3027
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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 | 004526
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License Number State | KY
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