Provider Demographics
NPI:1285726034
Name:GREENWOOD, DOUGLAS (LPT)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 STERNS RD
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9578
Mailing Address - Country:US
Mailing Address - Phone:734-224-7073
Mailing Address - Fax:734-224-7074
Practice Address - Street 1:3604 STERNS RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9578
Practice Address - Country:US
Practice Address - Phone:734-224-7073
Practice Address - Fax:734-224-7074
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2047074Medicaid
OHGR0703161Medicare ID - Type Unspecified
OH2047074Medicaid