Individual
MR. EDWARD GLENDON GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPH, PT
Contact information
Practice address
2500 NILES RD, STE 8, SAINT JOSEPH, MI 49085-3237
(269) 428-7150
(269) 428-7152
Mailing address
1456 HIDEAWAY LN, SAINT JOSEPH, MI 49085-9711
(269) 408-0876
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2576
MD
225100000X
Physical Therapist
5501006499
MI
225100000X
Physical Therapist
Primary
PT41112
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17498
PT LICENCE NUMBER MA
MA
01
—
5501006499
PT LICENCE NUMBER MI
MI
01
—
650A111540
BCBSM
MI
Enumeration date
11/03/2006
Last updated
08/09/2019
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