Provider Demographics
NPI:1497599716
Name:GREENE, DAVID ALLEN (LMT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:GREENE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 FIRE FLY LANE
Mailing Address - Street 2:
Mailing Address - City:RICE
Mailing Address - State:VA
Mailing Address - Zip Code:23966
Mailing Address - Country:US
Mailing Address - Phone:434-665-5667
Mailing Address - Fax:
Practice Address - Street 1:1700B S MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2537
Practice Address - Country:US
Practice Address - Phone:434-264-6169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019019818225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist