Individual
HAZE GREEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8000 ILIFF DR, DUNN LORING, VA 22027-1235
(703) 560-1000
Mailing address
8000 ILIFF DR, DUNN LORING, VA 22027-1235
(703) 560-1000
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306001477
VA
Other
Enumeration date
11/27/2015
Last updated
11/27/2015
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