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General NPI Number Information
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NPI Number | 1255784039
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Entity Type | Individual
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Provider Name | ALEXANDER RYAN GREEN ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 7500 SW 30TH ST
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City | DAVIE
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State | FL
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Zip | 33314-1020
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Country | US
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Telephone | 610-392-9785
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 SW 82ND TER APT 423
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City | PLANTATION
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State | FL
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Zip | 33324-3251
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Country | US
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Telephone | 610-392-9785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL4493
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT1168
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License Number State | KY
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