Provider Demographics
NPI:1093257818
Name:GREENE, LINDA ANNAN (DPT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ANNAN
Last Name:GREENE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:KATHRYN
Other - Last Name:ANNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:10505 SORRENTO VALLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10505 SORRENTO VALLEY RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1618
Practice Address - Country:US
Practice Address - Phone:858-793-7860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist