| Doctor Name: | RANDALL GREEN |
| NPI Number: | 1457352056 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | AR482 |
| Business Practice Address: | 1115 Ferguson Dr Benton, AR - 720153512 |
| Business Phone Number: | 5013150639 |
| Business Fax Number: | 5013157278 |
| Mailing Address: | 1115 Ferguson Dr, BENTON |
| State: | AR |
| Postal Code: | 720153512 |
| Phone Number: | 5013150639 |
| Fax Number: | 5013157278 |
| NPI Enumeration Date: | 08/03/2005 |
| NPI Last Update Date: | 06/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/27/2006 |
| NPI Reactivation Date: | 04/07/2006 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | AR482 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |