Active NPI
Jenna Green
- Physical Therapist
- Mankato, MN
National Provider Identifier
1609488121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11921
- Practice address
- 100 Dublin Rd
Mankato, MN 56001-8765 - Phone
- (507) 385-7094
- NPI assigned
- Aug 17, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 14974 | WI | |
| Physical Therapist | 225100000X | 11921 | MN | Primary |
Addresses
Primary practice location
100 Dublin Rd
Mankato, MN 56001-8765
Mailing address
100 Dublin Rd
Mankato, MN 56001-8765
Other practice location 1
1320 Wisconsin St
Hudson, WI 54016-1861
Phone (715) 386-9303
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597622400000",
"number": "1609488121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 DUBLIN RD",
"city": "MANKATO",
"state": "MN",
"postal_code": "560018765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 DUBLIN RD",
"city": "MANKATO",
"state": "MN",
"postal_code": "560018765",
"telephone_number": "507-385-7094"
}
],
"practiceLocations": [
{
"address_1": "1320 Wisconsin St",
"address_purpose": "LOCATION",
"city": "Hudson",
"state": "WI",
"postal_code": "540161861",
"country_code": "US",
"telephone_number": "715-386-9303",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GREEN",
"first_name": "JENNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-17",
"last_updated": "2020-08-17",
"certification_date": "2020-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "14974",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "11921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mankato, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.