Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 41794 | CA |
NPI | 1003211657 |
---|---|
Provider Name | Adrianne Greene |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Dover, DE 19904-4802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2014 |
Last Update Date | 18/05/2016 |