Individual
MRS. TONI GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
400 S 74TH ST, BELLEVILLE, IL 62223
(618) 580-9629
Mailing address
400 S 74TH ST, BELLEVILLE, IL 62223
(618) 580-9629
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.007384
IL
Other
Enumeration date
12/06/2012
Last updated
12/06/2012
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