Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4093 | OK |
N | 2251G0304X | Physical Therapist - Geriatrics | 4093 | OK |
N | 2251S0007X | Physical Therapist - Sports | 4093 | OK |
N | 2251X0800X | Physical Therapist - Orthopedic | 4093 | OK |
NPI | 1194925115 |
---|---|
Provider Name | Mr. Bryan Lynn Green |
First Address | Norman, OK 73072-4843 |
Second Address | Norman, OK 73072-4843 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 27/02/2020 |