Provider Demographics
NPI:1487452587
Name:GREEN, MARQUITA KALITHIA (LMT)
Entity type:Individual
Prefix:MS
First Name:MARQUITA
Middle Name:KALITHIA
Last Name:GREEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-3716
Mailing Address - Country:US
Mailing Address - Phone:215-444-5777
Mailing Address - Fax:
Practice Address - Street 1:1010 FOX CHASE RD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4124
Practice Address - Country:US
Practice Address - Phone:484-944-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG015922225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist