Individual
STACY WAYNE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1907 REFINERY RD, GAINESVILLE, TX 76240-2111
(940) 665-9314
Mailing address
6220 DEER RUN RD, SANGER, TX 76266-8211
(940) 206-5482
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2125935
TX
Other
Enumeration date
10/10/2018
Last updated
10/10/2018
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