Basic Information
| Provider Information | |||||||||
| NPI: | 1780977090 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GREEN | ||||||||
| FirstName: | HERMAN | ||||||||
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| Credential: | P. T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10117 DEER CHASE | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210461357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372964232 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1250 CONNECTICUT AVE NW | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200362603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2022616598 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2011 | ||||||||
| LastUpdateDate: | 05/19/2011 | ||||||||
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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 | 225100000X | PT871157 | DC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 23195 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.