Individual
JORDAN MATTHEW GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 S 2ND ST, STILWELL, OK 74960-3838
(918) 696-7220
Mailing address
363 HIDDEN GLEN TRL, KANSAS, OK 74347-9393
(405) 519-2228
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
180477
OK
Other
Enumeration date
03/01/2024
Last updated
03/01/2024
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