Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 3531 | OK |
NPI | 1073034740 |
---|---|
Provider Name | Mr. Joel Weston Greene |
First Address | Blanchard, OK 73010-3727 |
Second Address | Oklahoma City, OK 73104-5004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2017 |
Last Update Date | 03/07/2017 |