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Individual

MRS. JENNIFER MARIE GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
305 CLYDE MORRIS BLVD, SUITE 220, ORMOND BEACH, FL 32174-8181
(386) 676-3130
(386) 676-7572
Mailing address
1377 SPRING GARDEN RANCH RD, DE LEON SPRINGS, FL 32130-4210
(386) 985-5783

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA19986
FL

Other

Enumeration date
09/05/2007
Last updated
09/05/2007
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