Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A1015 | MD |
NPI | 1023020054 |
---|---|
Provider Name | Jeanette S Green |
First Address | Cockeysville, MD 21030-2506 |
Second Address | Cockeysville, MD 21030-2506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |