Provider Demographics
NPI:1174903066
Name:GREENE, BRIAN DANIEL (ATC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DANIEL
Last Name:GREENE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 WINDYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-9619
Mailing Address - Country:US
Mailing Address - Phone:207-712-9808
Mailing Address - Fax:
Practice Address - Street 1:289 WINDYWOOD RD
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-9619
Practice Address - Country:US
Practice Address - Phone:207-712-9808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer