MEDICARE: ASHLEY GREEN PT, DPT, LAT, ATC

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	27754	MD
2	2255A2300X	Athletic Trainer	A0001434	MD
3	2255A2300X	Athletic Trainer	AT23000065	DC

General Provider Information

NPI Number	:	1881226215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY GREEN PT, DPT, LAT, ATC

Provider Business Mailing Address
First Line	:	8344 ANALEE AVE
Second Line	:
City	:	ROSEDALE
State	:	MD
Zip	:	21237-1649
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 OAK DR SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-5953
Country	:	US
Telephone Number	:	202-628-3200
Fax Number	:

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

Provider Enumeration Date	:	02/04/2020
Last Update Date	:	03/06/2024

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