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1053197731 NPI number — MYLINH GILLESPIE LMT, BCTMB, CLT

NPI Number: 1053197731
Health Care Provider/Practitioner: MYLINH GILLESPIE LMT, BCTMB, CLT

Information about “1053197731” NPI (MYLINH GILLESPIE LMT, BCTMB, CLT) exists in 1053197731 in HTML format HTML  |  1053197731 in plain Text format TXT  |  1053197731 in PDF (Portable Document Format) PDF  |  1053197731 in an XML format XML  formats.

NPI Number : 1053197731 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053197731",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GILLESPIE",
    "FirstName": "MYLINH",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMT, BCTMB, CLT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "700 HICKORY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEWTON",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62448-1010",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "618-406-6684",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8341 N 1150TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEWTON",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62448-4040",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "618-255-7256",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/07/2023",
    "LastUpdateDate": "09/07/2023",
    "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": "225700000X",
        "TaxonomyName": "Massage Therapist",
        "LicenseNumber": "227021928",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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