Individual
RANDALL GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1115 FERGUSON DR, BENTON, AR 72015-3512
(501) 315-0639
(501) 315-7278
Mailing address
1115 FERGUSON DR, BENTON, AR 72015-3512
(501) 315-0639
(501) 315-7278
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
AR482
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117798721
—
AK
Enumeration date
08/03/2005
Last updated
06/05/2008
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