Individual
DANIEL A GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
921 S 8TH AVE, POCATELLO, ID 83201-5377
(208) 282-4636
Mailing address
905 S 3RD AVE APT 2, POCATELLO, ID 83201-6606
(208) 283-2992
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/26/2025
Last updated
02/26/2025
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