Individual
DESTINEE SIMONE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4646 JOHN R ST, DETROIT, MI 48201-1916
(313) 576-1000
Mailing address
27408 STRAWBERRY LN APT 202, FARMINGTON HILLS, MI 48334-5065
(313) 522-3660
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502008400
MI
Other
Enumeration date
03/17/2025
Last updated
03/17/2025
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