Healthcare Provider Details

I. General information

NPI: 1467362749
Provider Name (Legal Business Name): TYLER MICHAEL GREEN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 HAGER ST
BUFFALO NY
14208-1327
US

IV. Provider business mailing address

55 POPLAR CT
BUFFALO NY
14226-3645
US

V. Phone/Fax

Practice location:
  • Phone: 716-886-4377
  • Fax:
Mailing address:
  • Phone: 607-281-8109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056093
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: