Healthcare Provider Details

I. General information

NPI: 1487518619
Provider Name (Legal Business Name): OWEN GREEN PT, DPT, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 S GULPH RD STE 310
KING OF PRUSSIA PA
19406-3687
US

IV. Provider business mailing address

4329 GLENSIDE DR
READING PA
19605-3232
US

V. Phone/Fax

Practice location:
  • Phone: 610-265-2230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT033865
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: