NPI Code Detail JSON Logo

1043031933 NPI number — IRON OAK PHYSICAL THERAPY AND PERFORMANCE LLC KYLE GOODWIN SOLE MBR

NPI Number: 1043031933
Health Care Provider/Practitioner: IRON OAK PHYSICAL THERAPY AND PERFORMANCE LLC KYLE GOODWIN SOLE MBR

Information about “1043031933” NPI (IRON OAK PHYSICAL THERAPY AND PERFORMANCE LLC KYLE GOODWIN SOLE MBR) exists in 1043031933 in HTML format HTML  |  1043031933 in plain Text format TXT  |  1043031933 in PDF (Portable Document Format) PDF  |  1043031933 in an XML format XML  formats.

NPI Number : 1043031933 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043031933",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "IRON OAK PHYSICAL THERAPY AND PERFORMANCE LLC KYLE GOODWIN SOLE MBR",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "156 SECRETARIAT DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SUFFOLK",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23435-1786",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "443-366-4757",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "624 INNOVATION DR STE 105",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHESAPEAKE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23320-3867",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "443-366-4757",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/23/2024",
    "LastUpdateDate": "10/23/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GOODWIN",
    "AuthorizedOfficialFirstName": "KYLE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PT, DPT",
    "AuthorizedOfficialTelephoneNumber": "443-366-4757",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QP2000X",
        "TaxonomyName": "Physical Therapy Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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