Individual
MR. JACK CLAYTON GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
100 FITNESS DR, FUQUAY VARINA, NC 27526-7263
(919) 557-3100
(919) 557-3177
Mailing address
PO BOX 1492, FUQUAY VARINA, NC 27526-1492
(919) 557-3100
(919) 557-3177
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P12811
NC
Other
Enumeration date
08/31/2010
Last updated
08/31/2010
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