Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT006568 | GA |
NPI | 1033729397 |
---|---|
Provider Name | Kathleen O'neill Greene |
First Address | Woodstock, GA 30188-2323 |
Second Address | Roswell, GA 30076-3418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2020 |
Last Update Date | 03/08/2020 |