Tracy Michelle Green, PTA
Individual provider Active NPI Physical Therapy Assistant · Amber, OK
NPI 1285085696 · NPPES record last updated Jun 27, 2016
Key facts
- NPI
- 1285085696
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 568 (OK)
- Practice address
- 1521 County Road 1320
Amber, OK 73004-5525 - Phone
- (405) 574-2721
- NPI assigned
- Jun 27, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 568 | OK | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 568 | OK | Yes |
Addresses
Primary practice location
1521 County Road 1320
Amber, OK 73004-5525
Mailing address
1521 County Road 1320
Amber, OK 73004-5525
Phone (405) 574-2721
Other providers in Amber, OK
All providers in Amber, OK · Physical Therapy Assistant in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.