Provider Demographics
NPI:1588946602
Name:GREENE, PAULA ANN (DPT, OCS, CMPT)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:ANN
Last Name:GREENE
Suffix:
Gender:F
Credentials:DPT, OCS, CMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 TRACIE TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-9148
Mailing Address - Country:US
Mailing Address - Phone:218-770-6678
Mailing Address - Fax:
Practice Address - Street 1:4450 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-5611
Practice Address - Country:US
Practice Address - Phone:325-481-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61098225100000X
WAPT60240864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1588946602Medicaid
OR500695691Medicaid
WAG8950923Medicare PIN
ORR186719Medicare PIN
ORR186720Medicare PIN
WA1588946602Medicaid
OR500695691Medicaid
ORR186717Medicare PIN