MEDICARE: HERMAN GREEN 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	PT871157	DC
2	225100000X	Physical Therapist	23195	MD

General Provider Information

NPI Number	:	1780977090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERMAN GREEN P. T.

Provider Business Mailing Address
First Line	:	10117 DEER CHASE
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-1357
Country	:	US
Telephone Number	:	337-296-4232
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 CONNECTICUT AVE NW
Second Line	:	SUITE 200
City	:	WASHINGTON
State	:	DC
Zip	:	20036-2603
Country	:	US
Telephone Number	:	202-261-6598
Fax Number	:

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

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	05/19/2011

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