Healthcare Provider Details

I. General information

NPI: 1841751674
Provider Name (Legal Business Name): COURTNEY L GREEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9288 STOUTS RD
KIMBERLY AL
35091-2005
US

IV. Provider business mailing address

9288 STOUTS RD
KIMBERLY AL
35091-2005
US

V. Phone/Fax

Practice location:
  • Phone: 256-708-0329
  • Fax: 205-543-6910
Mailing address:
  • Phone: 256-708-0329
  • Fax: 205-543-6910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY GREEN
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 256-708-0329