MEDICARE: BRIDGETTE GREENE

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		FL
2	225700000X	Massage Therapist	MA71842	FL

General Provider Information

NPI Number	:	1821606682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGETTE GREENE

Provider Business Mailing Address
First Line	:	5433 54TH WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-7109
Country	:	US
Telephone Number	:	347-366-2877
Fax Number	:

Provider Business Practice Location Address
First Line	:	5433 54TH WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-7109
Country	:	US
Telephone Number	:	347-366-2877
Fax Number	:

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

Provider Enumeration Date	:	07/17/2020
Last Update Date	:	07/17/2020

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Directions to “ BRIDGETTE GREENE ” Practice Location

Language	Start Address	Practice Location

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