{
"Npi": {
"NPI": "1194264267",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GREEN HEALTH, PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "231 34TH AVE SW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORMAN",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73072-4843",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "512-924-8890",
"MailingAddressFaxNumber": "888-558-6690",
"FirstLinePracticeLocationAddress": "231 34TH AVE SW",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORMAN",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "73072-4843",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "405-593-8353",
"PracticeLocationAddressFaxNumber": "888-558-6690",
"EnumerationDate": "02/22/2017",
"LastUpdateDate": "06/01/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GREEN",
"AuthorizedOfficialFirstName": "BRYAN",
"AuthorizedOfficialMiddleName": "LYNN",
"AuthorizedOfficialTitle": "OWNER/PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "512-924-8890",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}