MEDICARE: GROW WITH GREENE, PT

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1578030227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROW WITH GREENE, PT

Provider Business Mailing Address
First Line	:	2201 LONG PRAIRIE RD STE 107-273
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4832
Country	:	US
Telephone Number	:	469-275-1399
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 LONG PRAIRIE RD STE 107-273
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4832
Country	:	US
Telephone Number	:	469-275-1399
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MONICA ROSE GREENE
Credential	:	PT
Telephone Number	:	469-275-1399

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	10/31/2018

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