Individual provider Active NPI

Danielle Green, PT, DPT

  • Physical Therapist
  • Beaver Dam, WI
National Provider Identifier
1962070425
Registry record updated Jun 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
15430-24 Issued in WI
Practice address
201 Gateway Dr Ste 300
Beaver Dam, WI 53916-9176
Phone
(800) 974-4378
Fax
(630) 515-1536
NPI assigned
Jun 11, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 15430-24 WI Primary

Addresses

Primary practice location

201 Gateway Dr Ste 300
Beaver Dam, WI 53916-9176

Mailing address

24014 W Renwick Rd Ste F
Plainfield, IL 60544-8708
Phone (800) 974-4378

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230404002496 WA Practitioner - Physical Therapist in Private Practice 6204237258 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Mar 10, 2023 Accepting new patients
Multicare Health System CurrentSince Mar 10, 2023 Accepting new patients

Locations

407 E Main St
Auburn, WA 98002
Phone (253) 545-0044

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1623369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623369600000",
    "number": "1962070425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24014 W RENWICK RD STE F",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605448708",
            "telephone_number": "800-974-4378",
            "fax_number": "630-515-1536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 GATEWAY DR STE 300",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539169176",
            "telephone_number": "800-974-4378",
            "fax_number": "630-515-1536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "DANIELLE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-11",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "15430-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver Dam, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.