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General NPI Number Information
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NPI Number | 1639258288
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Entity Type | Individual
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Provider Name | EDWARD GLENDON GREENE MPH, PT
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Gender | Male
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 2500 NILES RD STE 8
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-3237
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Country | US
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Telephone | 269-428-7150
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Fax | 269-428-7152
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Provider Business Mailing Address
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Address Line | 1456 HIDEAWAY LN
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-9711
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Country | US
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Telephone | 269-408-0876
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2576
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501006499
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT41112
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License Number State | CA
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