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1033234752 NPI number — ROBERTA M BREIDENBACH P.T.

NPI Number: 1033234752
Health Care Provider/Practitioner: ROBERTA M BREIDENBACH P.T.

Information about “1033234752” NPI (ROBERTA M BREIDENBACH P.T.) exists in 1033234752 in HTML format HTML  |  1033234752 in plain Text format TXT  |  1033234752 in PDF (Portable Document Format) PDF  |  1033234752 in an XML format XML  formats.

NPI Number : 1033234752 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033234752",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BREIDENBACH",
    "FirstName": "ROBERTA",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "P.T.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILLIS",
    "OtherFirstName": "ROBERTA",
    "OtherMiddleName": "M",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PHYSICAL THERAPIST",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1625 MEDICAL CENTER PT",
    "SecondLineMailingAddress": "SUITE 100",
    "MailingAddressCityName": "COLORADO SPRINGS",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80907-8731",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "719-494-1409",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1625 MEDICAL CENTER PT",
    "SecondLinePracticeLocationAddress": "SUITE 100",
    "PracticeLocationAddressCityName": "COLORADO SPRINGS",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80907-8731",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "719-474-1404",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/20/2007",
    "LastUpdateDate": "05/04/2010",
    "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": "5614",
        "LicenseNumberStateCode": "CO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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