Provider Demographics
NPI:1366562217
Name:GREEN, PRINCE ELLA
Entity type:Individual
Prefix:MRS
First Name:PRINCE
Middle Name:ELLA
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4047 OCKEECHOBEE BLVD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409
Mailing Address - Country:US
Mailing Address - Phone:561-385-0868
Mailing Address - Fax:
Practice Address - Street 1:4047 OCKEECHOBEE BLVD
Practice Address - Street 2:SUITE 123
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:561-385-0868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2012-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10159225X00000X
FLPT19439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist