Provider Demographics
NPI:1659772036
Name:GREENIDGE, SANTRESA (PT, DPT, LMT)
Entity type:Individual
Prefix:DR
First Name:SANTRESA
Middle Name:
Last Name:GREENIDGE
Suffix:
Gender:F
Credentials:PT, DPT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 EDWARD KELLEHER DR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3178
Mailing Address - Country:US
Mailing Address - Phone:857-206-0914
Mailing Address - Fax:
Practice Address - Street 1:67 EDWARD KELLEHER DR
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3178
Practice Address - Country:US
Practice Address - Phone:857-206-0914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist