Basic Information
| Provider Information | |||||||||
| NPI: | 1124272836 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENE | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13237 TRIADELPHIA RD | ||||||||
| Address2: | |||||||||
| City: | ELLICOTT CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210421140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017763665 | ||||||||
| FaxNumber: | 3017766669 | ||||||||
| Practice Location | |||||||||
| Address1: | 14435 CHERRY LANE CT | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207074959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017763665 | ||||||||
| FaxNumber: | 3017766669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2008 | ||||||||
| LastUpdateDate: | 11/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | T6408 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.