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
- 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 and National Provider Directory roles.
-
- Physical Therapist
- Silverdale, WA
- NPI 1437291176
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.