Edward Glendon Greene, MPH, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT41112 Issued in CA

Practice address

2500 Niles Rd
Ste 8
Saint Joseph, MI 49085-3237

Phone

(269) 428-7150

Fax

(269) 428-7152

NPI assigned

Nov 3, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Alliance Physical Therapy Group LLC

  • Physical Therapist
  • Holland, MI
  • NPI 1649216144
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565308800000",
    "number": "1639258288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1456 HIDEAWAY LN",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859711",
            "telephone_number": "269-408-0876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NILES RD",
            "address_2": "STE 8",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853237",
            "telephone_number": "269-428-7150",
            "fax_number": "269-428-7152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENE",
        "first_name": "EDWARD",
        "middle_name": "GLENDON",
        "name_prefix": "Mr.",
        "credential": "MPH, PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2019-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "2576",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501006499",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT41112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "650A111540",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENCE NUMBER MA",
            "identifier": "17498",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENCE NUMBER MI",
            "identifier": "5501006499",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Great Lakes Heart & Vascular Institute, P.C.
• Great Lakes Sports Medicine and Concussion Clinic
• Great Lakes Surgery Center LLC
• Mark H Greenberg, MD
• Adrienne Greene, DPT
• Samuel Z Gregor, CRNA
• Gregory E. Bauman, DDS, PLC
• Grace Elizabeth Greig, MD
• Amelia Griffin
• Marilyn Jane Griffiths, T.L.L.P.

• Physical Therapist in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.