Individual
DAVID GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 W. KENNEDY BLVD BOX: I, TAMPA, FL 33606
(813) 257-3561
Mailing address
401 W. KENNEDY BLVD BOX: I, TAMPA, FL 33606
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1012095
NATA MEMBER NUMBER
—
Enumeration date
08/01/2019
Last updated
08/01/2019
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