MEDICARE: JENNIFER NICOLE GREEN LPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2306606099	VA

General Provider Information

NPI Number	:	1033054457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NICOLE GREEN LPTA

Provider Business Mailing Address
First Line	:	11313 FARM RD
Second Line	:
City	:	SALUDA
State	:	VA
Zip	:	23149-2853
Country	:	US
Telephone Number	:	276-232-0155
Fax Number	:

Provider Business Practice Location Address
First Line	:	74 MIZPAH RD
Second Line	:
City	:	LOCUST HILL
State	:	VA
Zip	:	23092-9808
Country	:	US
Telephone Number	:	804-824-4748
Fax Number	:	804-824-4748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

Similar Medicare Providers

1629575998 — WILLIAM ALEXANDER COLE
Practice Location Address:

74 MIZPAH RD
LOCUST HILL, VA
23092-9808

Practice Phone: 804-758-5260
Practice Fax:

1548277734 — MIZPAH NURSING HOME INC
Practice Location Address:

74 MIZPAH ROAD
LOCUST HILL, VA
23092-0070

Practice Phone: 804-758-5260
Practice Fax: 804-758-0953

1497135727 — MIZPAH HEALTHCARE GROUP LLC
Practice Location Address:

74 MIZPAH ROAD
LOCUST HILL, VA
23092

Practice Phone: 804-758-5260
Practice Fax: 804-758-0953

1811355407 — ASHLEY VANHATTEN OTRL
Practice Location Address:

74 MARSH PUNGO ROAD
LOCUST HILL, VA
23092

Practice Phone: 804-758-5260
Practice Fax:

1376031286 — MRS. LORETTA PARHAM-FRIDAY MA-SLP
Practice Location Address:

823 PHILPOT RD
LOCUST HILL, VA
23092-9746

Practice Phone: 804-758-2496
Practice Fax:

1467940924 — IVA JEAN SMITH
Practice Location Address:

823 PHILPOT RD
LOCUST HILL, VA
23092-9746

Practice Phone: 804-758-2496
Practice Fax:

Directions to “ JENNIFER NICOLE GREEN LPTA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.