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1033587803 NPI number — JODI DIEDRICH AT, ATC

NPI Number: 1033587803
Health Care Provider/Practitioner: JODI DIEDRICH AT, ATC

Information about “1033587803” NPI (JODI DIEDRICH AT, ATC) exists in 1033587803 in HTML format HTML  |  1033587803 in plain Text format TXT  |  1033587803 in PDF (Portable Document Format) PDF  |  1033587803 in an XML format XML  formats.

NPI Number : 1033587803 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033587803",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DIEDRICH",
    "FirstName": "JODI",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "AT, ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1632 BRIEDWENG AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAYTON",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45420-2116",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2400 MIAMI VALLEY DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CENTERVILLE",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "45459-4774",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "920-838-3359",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/09/2015",
    "LastUpdateDate": "06/10/2016",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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