MEDICARE: CODY GREEN

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	002581	WV

General Provider Information

NPI Number	:	1831915214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY GREEN

Provider Business Mailing Address
First Line	:	400 TRACY WAY STE 100
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-1280
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 BRIDLEWOOD RD
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25314-2101
Country	:	US
Telephone Number	:	304-550-6935
Fax Number	:

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

Provider Enumeration Date	:	12/02/2024
Last Update Date	:	12/02/2024

Similar Medicare Providers

1033721543 — PATRICIA LYNN SMITH
Practice Location Address:

323 BERKELEY ST APT B
CHARLESTON, WV
25302-2101

Practice Phone: 304-205-4489
Practice Fax:

1497507594 — MRS. KRYSTLE NICOLE HURON FNP-C
Practice Location Address:

1162A ARNOLD CIR
CHARLESTON AFB, SC
29404-2101

Practice Phone: 402-949-2553
Practice Fax:

1003882150 — DR. KAJAL DASGUPTA M.D.
Practice Location Address:

2101 E JEFFERSON ST , KAISER PERMANENTE MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-2424
Practice Fax:

1881646115 — MS. MELISSA RYAN STRAUSS P.A.
Practice Location Address:

2101 E JEFFERSON ST , KAISER PERMANENTE MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-2424
Practice Fax:

1497832083 — DR. LYSA CHARLES MD
Practice Location Address:

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

1467527317 — DR. MICHAEL B HALLE MD
Practice Location Address:

2101 E JEFFERSON ST , KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 701-922-1000
Practice Fax: 703-922-1039

Directions to “ CODY GREEN ” 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.