Individual
MR. KEVIN O'SHEA GREEN SR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PTA, MLDT
Contact information
Practice address
1076 RIBAUT RD, BEAUFORT, SC 29902-5490
(832) 521-1970
Mailing address
133 BAYNARD RD, BEAUFORT, SC 29906-6777
(843) 597-0993
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
948
SC
Other
Enumeration date
03/24/2006
Last updated
07/08/2007
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