Khadijah Afiya Greene

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA30434 Issued in FL

Practice address

830 29TH St
Orlando, FL 32805-6219

Phone

(407) 843-3230

NPI assigned

Feb 9, 2021

Last updated

Feb 9, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612828800000",
    "number": "1194317297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9012 SUMMIT CENTRE WAY APT 204",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328105957",
            "telephone_number": "786-800-0381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 29TH ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328056219",
            "telephone_number": "407-843-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENE",
        "first_name": "KHADIJAH",
        "middle_name": "AFIYA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-09",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA30434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Greenberg, LCSW
• Greene Preserve Investment LLC
• Emily Faith Greene
• Florence Diallo Greene
• Kellerie Dawn Greene, ARNP, FNP-C
• Patricia Greene
• Rebecca Elizabeth Greene, PHARM.D.
• Sareena Monique Greene
• Tabatha Y Greene
• Greenehouse OT LLC

• Physical Therapy Assistant in Orlando, FL
• Providers in Orlando, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.