Basic Information
| Provider Information | |||||||||
| NPI: | 1639282007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MS, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 PENNSYLVANIA PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462802301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182085112 | ||||||||
| FaxNumber: | 3178171220 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 PENNSYLVANIA PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462802301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182085112 | ||||||||
| FaxNumber: | 3178171220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 07/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT001318 | GA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 2255A2300X | 36001750A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.