Individual
MRS. KELLI SUZANNE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
111 W 36TH ST, SCOTTSBLUFF, NE 69361-4636
(308) 635-2019
Mailing address
2202 HIGHLAND DR, SCOTTSBLUFF, NE 69361-4809
(402) 616-3389
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
557
NE
Other
Enumeration date
07/27/2011
Last updated
07/27/2011
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