Provider Demographics
NPI:1356159198
Name:GREEN, JERMAINE JR (DPT)
Entity type:Individual
Prefix:DR
First Name:JERMAINE
Middle Name:
Last Name:GREEN
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12494
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-2494
Mailing Address - Country:US
Mailing Address - Phone:229-379-6351
Mailing Address - Fax:
Practice Address - Street 1:1329 ABRAHAM ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-1907
Practice Address - Country:US
Practice Address - Phone:850-224-8486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist