Provider Demographics
NPI:1427461748
Name:GREEN, MICHAEL STEPHEN (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:GREEN
Suffix:
Gender:M
Credentials:DPT
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Mailing Address - Street 1:4200 DAHLBERG DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4840
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5651
Practice Address - Street 1:4570 CHURCHILL ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-2273
Practice Address - Country:US
Practice Address - Phone:651-451-1071
Practice Address - Fax:651-481-0042
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2015-03-05
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Provider Licenses
StateLicense IDTaxonomies
NCP14894225100000X
MT5941225100000X
MN98822251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist