Active NPI
Kelli Suzanne Green, PTA
- Physical Therapy Assistant
- Scottsbluff, NE
National Provider Identifier
1386922110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 557
- Practice address
- 111 W 36TH St
Scottsbluff, NE 69361-4636 - Phone
- (308) 635-2019
- NPI assigned
- Jul 27, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 Therapy Assistant | 225200000X | 557 | NE | Primary |
Addresses
Primary practice location
111 W 36TH St
Scottsbluff, NE 69361-4636
Mailing address
2202 Highland Dr
Scottsbluff, NE 69361-4809
Phone (402) 616-3389
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 557 | NE | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311724800000",
"number": "1386922110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2202 HIGHLAND DR",
"city": "SCOTTSBLUFF",
"state": "NE",
"postal_code": "693614809",
"telephone_number": "402-616-3389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 W 36TH ST",
"city": "SCOTTSBLUFF",
"state": "NE",
"postal_code": "693614636",
"telephone_number": "308-635-2019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "KELLI",
"middle_name": "SUZANNE",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-27",
"last_updated": "2011-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapy Assistant",
"state": "NE",
"license": "557",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scottsbluff, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.