Individual
JONATHAN E GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
10450 W MCDOWELL RD, STE 102, AVONDALE, AZ 85392-4901
(623) 846-7614
(623) 846-0993
Mailing address
PO BOX 29870, PHOENIX, AZ 85038-9870
(602) 772-3800
(602) 772-3801
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7236
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107079
—
AZ
01
—
7236
LICENSE #
AZ
Enumeration date
08/30/2006
Last updated
01/29/2014
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