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Individual

MR. DEREK A GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
330 NE MARSHALL AVE, BEND, OR 97701-4346
(541) 383-8179
(541) 382-2879
Mailing address
330 NE MARSHALL AVE, BEND, OR 97701-4346
(541) 383-8179
(541) 382-2879

Taxonomy

Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
6254
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500652855
OR
Enumeration date
07/12/2010
Last updated
05/06/2014
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