1639107246 NPI number — MRS. CHRISTINE ANN GREENE D.P.T.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639107246 NPI number — MRS. CHRISTINE ANN GREENE D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENE
Provider First Name:
CHRISTINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOYRING
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639107246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 SUNSET DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOKOMIS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34275-3116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-484-2471
Provider Business Mailing Address Fax Number:
941-485-3574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 TAMIAMI TRL S STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VENICE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34285-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-484-2471
Provider Business Practice Location Address Fax Number:
941-484-5487
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT1538 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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