Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2928 | NC |
NPI | 1013288091 |
---|---|
Provider Name | Mrs. Lisa Hartley Greene |
First Address | Boomer, NC 28606-8198 |
Second Address | Yadkinville, NC 27055-8132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2012 |
Last Update Date | 23/01/2012 |