| Doctor Name: | MS. LISA DIANE GREEN |
| NPI Number: | 1528193240 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MOMT, MPT, ATC |
| License Number: | PT18800 |
| Business Practice Address: | 150 Portola Rd Ste. B Portola Valley, CA - 940287852 |
| Business Phone Number: | 6508511145 |
| Business Fax Number: | 6508519251 |
| Mailing Address: | 150 Portola Rd, Ste. B PORTOLA VALLEY |
| State: | CA |
| Postal Code: | 940287852 |
| Phone Number: | 6508511145 |
| Fax Number: | 6508519251 |
| NPI Enumeration Date: | 02/22/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | PT18800 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |