MEDICARE: MRS. JUDY A. GREENE P.T.

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	225100000X	Physical Therapist	001567	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000050162	OTHER	KY	ANTHEM PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558366773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDY A. GREENE P.T.

Provider Business Mailing Address
First Line	:	1910 S VIRGINIA ST
Second Line	:	STE 108
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-6008
Country	:	US
Telephone Number	:	270-885-9110
Fax Number	:	270-885-9110

Provider Business Practice Location Address
First Line	:	1910 S VIRGINIA ST
Second Line	:	STE 108
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-6008
Country	:	US
Telephone Number	:	270-885-9110
Fax Number	:	270-885-9110

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/09/2007

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