Taryn Green, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502004992 Issued in MI

Practice address

3950 Sumac Dr
Traverse City, MI 49684-7009

Phone

(231) 714-6516

NPI assigned

Jan 11, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1484092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716768000000",
    "number": "1760928055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 S HIGH ST",
            "city": "RANDOLPH",
            "state": "WI",
            "postal_code": "539561499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 SUMAC DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847009",
            "telephone_number": "231-714-6516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "TARYN",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-11",
        "last_updated": "2024-05-27",
        "certification_date": "2024-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502004992",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "2555",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Green Acres Afc
• Casey Nichole Green, PA-C
• Jenifer Lyn Green, CNP
• Katherine Green
• Nicole Lynn Green
• Timothy Green
• Kelly Kathleen Greene, PSY.D.
• Jill R Greenfield, PT
• Courtney Marie Greening, P.T.
• Greenlund Enterprises, Inc

• Physical Therapy Assistant in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2024; 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.