Individual
LORI GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
801 NW ST MARY'S DR, STE 102, BLUE SPRINGS, MO 64014
(816) 229-6622
Mailing address
1313 NE MAGNOLIA ST, LEES SUMMIT, MO 64086-5841
(816) 246-7928
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115189
LICENSE #
MO
Enumeration date
08/30/2006
Last updated
07/08/2007
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