Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | 007860-1 | NY |
NPI | 1093891145 |
---|---|
Provider Name | Mrs. Kristen M Green |
First Address | Chateaugay, NY 12920-3600 |
Second Address | Chateaugay, NY 12920-3600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 23/04/2021 |