Provider Demographics
NPI:1447927678
Name:GREENTREE, RICHARD DOUGLAS (DPT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DOUGLAS
Last Name:GREENTREE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 ERRINGER RD
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3525
Mailing Address - Country:US
Mailing Address - Phone:805-584-0001
Mailing Address - Fax:805-527-9135
Practice Address - Street 1:1922 ERRINGER RD
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3525
Practice Address - Country:US
Practice Address - Phone:805-584-0001
Practice Address - Fax:805-527-9135
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3008312251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic