Provider Demographics
NPI:1427891464
Name:TAYLOR-GREENGARD, AMY ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:TAYLOR-GREENGARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 HIGHWAY 100 S STE 103
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1599
Mailing Address - Country:US
Mailing Address - Phone:763-258-9978
Mailing Address - Fax:763-531-5004
Practice Address - Street 1:5200 OAK GROVE PKWY N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-4031
Practice Address - Country:US
Practice Address - Phone:763-258-9978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN64582251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics