Healthcare Provider Details

I. General information

NPI: 1194264267
Provider Name (Legal Business Name): GREEN HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 06/01/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 34TH AVE SW
NORMAN OK
73072-4843
US

IV. Provider business mailing address

231 34TH AVE SW
NORMAN OK
73072-4843
US

V. Phone/Fax

Practice location:
  • Phone: 405-593-8353
  • Fax: 888-558-6690
Mailing address:
  • Phone: 512-924-8890
  • Fax: 888-558-6690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRYAN LYNN GREEN
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 512-924-8890