Active NPI
Mary Ellen Green, PT
- Physical Therapist
- Chicago Ridge, IL
National Provider Identifier
1043769276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.005875
- Practice address
- 10255 Southwest Hwy
Chicago Ridge, IL 60415-1350 - Phone
- (708) 778-0115
- NPI assigned
- Sep 29, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070.005875 | IL | Primary |
Addresses
Primary practice location
10255 Southwest Hwy
Chicago Ridge, IL 60415-1350
Mailing address
646 Riford Rd
Glen Ellyn, IL 60137-3973
Phone (630) 942-1068
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.005875 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475107200000",
"number": "1043769276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "646 RIFORD RD",
"city": "GLEN ELLYN",
"state": "IL",
"postal_code": "601373973",
"telephone_number": "630-942-1068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10255 SOUTHWEST HWY",
"city": "CHICAGO RIDGE",
"state": "IL",
"postal_code": "604151350",
"telephone_number": "708-778-0115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "MARY",
"middle_name": "ELLEN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-29",
"last_updated": "2016-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.005875",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.