Provider Demographics
NPI:1487685103
Name:GREEN, HARRY JR (MPT)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:
Last Name:GREEN
Suffix:JR
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 RED BANK RD
Mailing Address - Street 2:
Mailing Address - City:EUTAWVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29048-9439
Mailing Address - Country:US
Mailing Address - Phone:718-413-8408
Mailing Address - Fax:
Practice Address - Street 1:134 RED BANK RD
Practice Address - Street 2:
Practice Address - City:EUTAWVILLE
Practice Address - State:SC
Practice Address - Zip Code:29048-9439
Practice Address - Country:US
Practice Address - Phone:718-413-8408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22193225100000X
GA008684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist