Provider Demographics
NPI:1730737966
Name:GREENE, LAURA (DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:168 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3561
Mailing Address - Country:US
Mailing Address - Phone:508-477-4800
Mailing Address - Fax:808-591-2245
Practice Address - Street 1:168 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3561
Practice Address - Country:US
Practice Address - Phone:508-477-4800
Practice Address - Fax:808-591-2245
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI3213OtherUNIVERSITY HEALTH ALLIANCE