Doctor Name: | DESTINE GREEN |
NPI Number: | 1790064061 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DPT |
License Number: | 1171880 |
Business Practice Address: | 827 Magnolia Blvd 827 S. Magnolia Blvd Magnolia, TX - 773558602 |
Business Phone Number: | 2812770751 |
Business Fax Number: | 2812770761 |
Mailing Address: | 827 Magnolia Blvd, 827 S. Magnolia Blvd MAGNOLIA |
State: | TX |
Postal Code: | 773558602 |
Phone Number: | 2812770751 |
Fax Number: | 2812770761 |
NPI Enumeration Date: | 08/04/2011 |
NPI Last Update Date: | 08/04/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 1171880 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
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 |