Provider Demographics
NPI:1184783342
Name:GREEN, PAULA (PT)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 ABERCORN ST STE 221
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5714
Mailing Address - Country:US
Mailing Address - Phone:912-228-9222
Mailing Address - Fax:912-354-4474
Practice Address - Street 1:403 COVE VIEW DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3204
Practice Address - Country:US
Practice Address - Phone:912-228-9222
Practice Address - Fax:912-354-4443
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0016842251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics