Healthcare Provider Details

I. General information

NPI: 1528506573
Provider Name (Legal Business Name): ROSEMARIE GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TWP MI
48038-3504
US

IV. Provider business mailing address

316 LONE PINE CIR
ROCHESTER MI
48307-6037
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-2481
  • Fax:
Mailing address:
  • Phone: 248-214-3266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number5501007051
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number5501007051
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501007051
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501007051
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: