Individual
GORDON K GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, OMT
Contact information
Practice address
2662 MCFARLAND RD, ROCKFORD, IL 61107-6806
(815) 227-1700
(815) 227-1744
Mailing address
2662 MCFARLAND RD, ROCKFORD, IL 61107-6806
(815) 227-1700
(815) 227-1744
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070-004702
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070-004702
PROFESSIONAL LICENSE
IL
Enumeration date
08/10/2006
Last updated
09/05/2012
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