Individual
MICHAEL GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4941 GARY DR, FORT MYERS, FL 33905-3633
(239) 980-6129
Mailing address
4941 GARY DR, FORT MYERS, FL 33905-3633
(239) 980-6129
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
10/23/2025
Last updated
10/23/2025
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