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General NPI Number Information
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NPI Number | 1871978601
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Entity Type | Individual
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Provider Name | SALLY GREEN
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Gender | Female
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 420 BREEZE ST
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City | CRAIG
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State | CO
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Zip | 81625-2620
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Country | US
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Telephone | 970-824-2483
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Fax | 970-824-2483
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Provider Business Mailing Address
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Address Line | 1984 PINE RIDGE TRL
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City | CRAIG
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State | CO
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Zip | 81625-8700
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Country | US
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Telephone | 970-824-2483
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Fax | 970-824-2483
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 1564
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License Number State | CO
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