Provider Demographics
NPI:1194264267
Name:GREEN HEALTH, PLLC
Entity type:Organization
Organization Name:GREEN HEALTH, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:512-924-8890
Mailing Address - Street 1:231 34TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4843
Mailing Address - Country:US
Mailing Address - Phone:512-924-8890
Mailing Address - Fax:888-558-6690
Practice Address - Street 1:231 34TH AVE SW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4843
Practice Address - Country:US
Practice Address - Phone:405-593-8353
Practice Address - Fax:888-558-6690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200754520AMedicaid