Individual
MS. LISA DIANE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOMT, MPT, ATC
Contact information
Practice address
150 PORTOLA RD, STE. B, PORTOLA VALLEY, CA 94028-7852
(650) 851-1145
(650) 851-9251
Mailing address
150 PORTOLA RD, STE. B, PORTOLA VALLEY, CA 94028-7852
(650) 851-1145
(650) 851-9251
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT18800
CA
Other
Enumeration date
02/22/2007
Last updated
07/08/2007
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