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NPI Code Detail

MEDICARE: JONATHAN E GREENE PT

MEDICARE: JONATHAN E GREENE PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist7236AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17236OTHERAZLICENSE #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316057060
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN E GREENE PT
Provider Business Mailing Address
First Line : PO BOX 29870
Second Line :
City : PHOENIX
State : AZ
Zip : 85038-9870
Country : US
Telephone Number : 602-772-3800
Fax Number : 602-772-3801
Provider Business Practice Location Address
First Line : 10450 W MCDOWELL RD
Second Line : STE 102
City : AVONDALE
State : AZ
Zip : 85392-4901
Country : US
Telephone Number : 623-846-7614
Fax Number : 623-846-0993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 01/29/2014

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Directions to “ JONATHAN E GREENE PT” Practice Location

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