Individual
KYLE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4876 NW BETHANY BLVD, SUITE L-1, PORTLAND, OR 97229-9259
(503) 466-2254
(503) 466-1143
Mailing address
511 SW 10TH AVE STE 101, PORTLAND, OR 97205-2700
(503) 294-7463
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
60040
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500654087
—
OR
Enumeration date
11/05/2012
Last updated
08/18/2015
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