Individual
MRS. PATRICIA LYNN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
118 MEDICAL DR, CARMEL, IN 46032-2923
(317) 577-3103
(317) 200-3965
Mailing address
15226 GOODTIME CT, CARMEL, IN 46032-1037
(317) 937-4317
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
060003159A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060003159A
INDIANA PROFESSIONAL LICENSING AGENCY
IN
Enumeration date
07/17/2017
Last updated
07/17/2017
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