Gordon K Green, PT, OMT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070-004702 Issued in IL

Practice address

2662 McFarland Rd
Rockford, IL 61107-6806

Phone

(815) 227-1700

Fax

(815) 227-1744

NPI assigned

Aug 10, 2006

Last updated

Sep 5, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Certified Hand Center of Rockford

  • Occupational Therapist
  • Rockford, IL
  • NPI 1366497109

  Physical Therapist

  NPD (past) Authorized official
• Orthopedic Rehab Specialists of Dixon, LLC

  • Physical Therapist
  • Dixon, IL
  • NPI 1679778435
  Authorized official Same address or phone
• Ortho Rehab Specialists PLLC

  • Physical Therapist
  • Rockford, IL
  • NPI 1891330882
  NPD

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346803200000",
    "number": "1649281452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2662 MCFARLAND RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076806",
            "telephone_number": "815-227-1700",
            "fax_number": "815-227-1744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2662 MCFARLAND RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076806",
            "telephone_number": "815-227-1700",
            "fax_number": "815-227-1744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "GORDON",
        "middle_name": "K",
        "credential": "PT, OMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2012-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-004702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "070-004702",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Great Smiles of Rockford
• Great Smiles of Rockford, LTD
• Christopher A Green, MD
• Christy Green, L.S.W.
• Daniel Robert Green, DNP, NP-C
• James Leitze Green, M.D.
• Maria Juanita Green
• Natalie Lea Green, COTA/L
• Rona Laticia Green, LPC
• Roger L Greenlaw, M.D.

• Physical Therapist in Rockford, IL
• Providers in Rockford, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2012; 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.