MEDICARE: ANTHONY J GREENE DPT

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
1	225100000X	Physical Therapist	5501016676	MI

General Provider Information

NPI Number	:	1790100071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY J GREENE DPT

Provider Business Mailing Address
First Line	:	600 OAKMONT LN STE 600C
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-5548
Country	:	US
Telephone Number	:	630-575-1980
Fax Number	:	630-928-5080

Provider Business Practice Location Address
First Line	:	3050 UNION LAKE RD
Second Line	:	STE 3C
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-4509
Country	:	US
Telephone Number	:	248-363-8267
Fax Number	:	248-363-8367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2014
Last Update Date	:	04/06/2018

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