Provider Demographics
NPI:1790100071
Name:GREENE, ANTHONY J (DPT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:GREENE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:3050 UNION LAKE RD
Practice Address - Street 2:STE 3C
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4509
Practice Address - Country:US
Practice Address - Phone:248-363-8267
Practice Address - Fax:248-363-8367
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist