Active NPI
Christine Green, PT, ATC
- Other Technician
- Kenosha, WI
National Provider Identifier
1528052172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- PT00005215
- Practice address
- 7822 28TH Ave
Kenosha, WI 53143-5622 - Phone
- (262) 764-0754
- NPI assigned
- Sep 8, 2005
- Last updated
- Mar 7, 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 |
|---|---|---|---|---|
| Other Technician | 247200000X | PT00005215 | WA | Primary |
Addresses
Primary practice location
7822 28TH Ave
Kenosha, WI 53143-5622
Mailing address
3420 Illinois St
Great Lakes, IL 60088-3161
Phone (847) 688-6755
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 |
|---|---|---|---|
| PT00005215 | WA | MD | Other Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sampson Enterprises Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457308800000",
"number": "1528052172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3420 ILLINOIS ST",
"city": "GREAT LAKES",
"state": "IL",
"postal_code": "600883161",
"telephone_number": "847-688-6755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7822 28TH AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531435622",
"telephone_number": "262-764-0754"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "CHRISTINE",
"credential": "PT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-08",
"last_updated": "2016-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "WA",
"license": "PT00005215",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.