Healthcare Provider Details

I. General information

NPI: 1760390397
Provider Name (Legal Business Name): ALEXANDER MICHAEL GREEN DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 NE MEDICAL CENTER DR STE 150
BEND OR
97701-5919
US

IV. Provider business mailing address

805 SW INDUSTRIAL WAY STE 3
BEND OR
97702-1093
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-7875
  • Fax: 541-382-2181
Mailing address:
  • Phone: 541-382-7875
  • Fax: 541-382-2181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number66228
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: