Individual
MICHAEL ANGELO GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
440 N RIVER ST, WILKES BARRE, PA 18702-2631
(570) 825-5611
Mailing address
RR 3 BOX 114, DALTON, PA 18414-9415
(570) 378-3242
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TE-001109-L
PA
Other
Enumeration date
03/26/2007
Last updated
07/08/2007
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