Provider Demographics
NPI:1912678517
Name:GREEN, REBEKAH MONET
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:MONET
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 SOUTHERN DR APT 915
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-5636
Mailing Address - Country:US
Mailing Address - Phone:623-910-8294
Mailing Address - Fax:
Practice Address - Street 1:1050 SOUTHERN DR APT 915
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-5636
Practice Address - Country:US
Practice Address - Phone:623-910-8294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer