NPI Code Detail JSON Logo

1033415807 NPI number — JENNIFER ANN MODZELEWSKI PTA

NPI Number: 1033415807
Health Care Provider/Practitioner: JENNIFER ANN MODZELEWSKI PTA

Information about “1033415807” NPI (JENNIFER ANN MODZELEWSKI PTA) exists in 1033415807 in HTML format HTML  |  1033415807 in plain Text format TXT  |  1033415807 in PDF (Portable Document Format) PDF  |  1033415807 in an XML format XML  formats.

NPI Number : 1033415807 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033415807",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MODZELEWSKI",
    "FirstName": "JENNIFER",
    "MiddleName": "ANN",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "PTA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "COUTO",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "PTA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "978 GIBRALTAR RD",
    "SecondLineMailingAddress": "UNIT 2",
    "MailingAddressCityName": "KEY LARGO",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33037-4609",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "586-524-3089",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4625 BAYSHORE DR APT D16",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NAPLES",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34112-4360",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "586-524-3089",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/26/2011",
    "LastUpdateDate": "05/18/2021",
    "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": "225200000X",
          "TaxonomyName": "Physical Therapy Assistant",
          "LicenseNumber": "5502002091",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225200000X",
          "TaxonomyName": "Physical Therapy Assistant",
          "LicenseNumber": "PTA25476",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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