Individual
KENNETH WALTER GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT, OM
Contact information
Practice address
307 ROCKMOOR DR, GEORGETOWN, TX 78628-8983
(512) 609-9188
Mailing address
307 ROCKMOOR DR, GEORGETOWN, TX 78628-8983
(512) 609-9188
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT122578
TX
Other
Enumeration date
07/10/2017
Last updated
07/21/2022
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