Provider Demographics
NPI:1194073627
Name:GREENE, KATHRYN PATRICE (DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PATRICE
Last Name:GREENE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SOUTHSIDE DR STE 206
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3894
Mailing Address - Country:US
Mailing Address - Phone:518-280-4294
Mailing Address - Fax:518-280-4297
Practice Address - Street 1:7 SOUTHSIDE DR STE 206
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3894
Practice Address - Country:US
Practice Address - Phone:518-280-4294
Practice Address - Fax:518-280-4297
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035173-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics