Kelly Green, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

31672 Issued in AZ

Practice address

1626 N Litchfield Rd Ste 310
Goodyear, AZ 85395-1397

Phone

(623) 680-0036

NPI assigned

Mar 25, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Select Rehabilitation, LLC

  • Rehabilitation Clinic/Center
  • Glenview, IL
  • NPI 1346368248

  AZ, Physical Therapist

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1104403195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7602 N 185TH AVE",
            "city": "WADDELL",
            "state": "AZ",
            "postal_code": "853559815",
            "telephone_number": "623-680-0036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1626 N LITCHFIELD RD STE 310",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853951397",
            "telephone_number": "623-680-0036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KELLY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-25",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "31672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna L Graham, PA-C
• Tashara Natashja Gray, MD
• Gary John Greco, PHARM D.
• Green Leaf Home Care Services
• Donald Joseph Green, MD
• Valarie Brookes Green
• Anthony Eugene Greenidge, AZ LISAC - 15204
• Luciana Gregory
• Julia Annette Gresham, PA
• Grind4Fitness Training LLC

• Physical Therapist in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.