Provider Demographics
NPI:1720405574
Name:GREEN, BRIAN L (DPT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:L
Last Name:GREEN
Suffix:
Gender:M
Credentials:DPT
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Mailing Address - Street 1:PO BOX 848644
Mailing Address - Street 2:APPALACHIAN ORTHOPAEDIC ASSOC.
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8644
Mailing Address - Country:US
Mailing Address - Phone:423-239-1550
Mailing Address - Fax:423-239-1544
Practice Address - Street 1:105 MEADOW VIEW RD STE 4
Practice Address - Street 2:APPALACHIAN REHABILITATION & SPORTS MEDICINE
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1726
Practice Address - Country:US
Practice Address - Phone:723-844-6935
Practice Address - Fax:423-652-0546
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN98912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic