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1023344397 NPI number — TRACEY BLACK POWELL PHYSICAL THERAPIST

NPI Number: 1023344397
Health Care Provider/Practitioner: TRACEY BLACK POWELL PHYSICAL THERAPIST

Information about “1023344397” NPI (TRACEY BLACK POWELL PHYSICAL THERAPIST) exists in 1023344397 in HTML format HTML  |  1023344397 in plain Text format TXT  |  1023344397 in PDF (Portable Document Format) PDF  |  1023344397 in an XML format XML  formats.

NPI Number : 1023344397 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023344397",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "POWELL",
    "FirstName": "TRACEY",
    "MiddleName": "BLACK",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHYSICAL THERAPIST",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BLACK",
    "OtherFirstName": "TRACEY",
    "OtherMiddleName": "ELAINE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1130 N CHURCH ST STE 201",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREENSBORO",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27401-1041",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1130 N CHURCH ST",
    "SecondLinePracticeLocationAddress": "SUITE 201",
    "PracticeLocationAddressCityName": "GREENSBORO",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27401-1038",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "336-275-2285",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/21/2009",
    "LastUpdateDate": "10/30/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "1762",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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