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1013080159 NPI number — MARY BETH RICHARDSON D.P.T.

NPI Number: 1013080159
Health Care Provider/Practitioner: MARY BETH RICHARDSON D.P.T.

Information about “1013080159” NPI (MARY BETH RICHARDSON D.P.T.) exists in 1013080159 in HTML format HTML  |  1013080159 in plain Text format TXT  |  1013080159 in PDF (Portable Document Format) PDF  |  1013080159 in an XML format XML  formats.

NPI Number : 1013080159 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1013080159",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RICHARDSON",
    "FirstName": "MARY BETH",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "D.P.T.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2051 MENALTO AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MENLO PARK",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94025-2628",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "650-575-1801",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "900 VETERANS BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "REDWOOD CITY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94063-1715",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "650-299-3940",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/16/2006",
    "LastUpdateDate": "12/20/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "10/11/2016",
    "NPIReactivationDate": "10/26/2016",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2251N0400X",
        "TaxonomyName": "Neurology Physical Therapist",
        "LicenseNumber": "PT 19049",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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