Provider Demographics
NPI:1093261679
Name:GREEN, BRONTE (DPT, PT)
Entity Type:Individual
Prefix:
First Name:BRONTE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 SUMMIT CENTRE WAY
Mailing Address - Street 2:APT 303
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5974
Mailing Address - Country:US
Mailing Address - Phone:407-756-4917
Mailing Address - Fax:
Practice Address - Street 1:811 SOUTH ORLANDO AVE
Practice Address - Street 2:#H CORA REHAB
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-539-1792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist