Individual
EBONI DA'SHAUN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
520 S HULL ST, MONTGOMERY, AL 36104-4610
(334) 834-2920
Mailing address
3912 NARROW LANE RD, MONTGOMERY, AL 36111-2644
(334) 220-3047
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA10477
AL
Other
Enumeration date
09/11/2021
Last updated
09/11/2021
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