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1053552703 NPI number — JAYNE LYNN FOX PT

NPI Number: 1053552703
Health Care Provider/Practitioner: JAYNE LYNN FOX PT

Information about “1053552703” NPI (JAYNE LYNN FOX PT) exists in 1053552703 in HTML format HTML  |  1053552703 in plain Text format TXT  |  1053552703 in PDF (Portable Document Format) PDF  |  1053552703 in an XML format XML  formats.

NPI Number : 1053552703 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053552703",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FOX",
    "FirstName": "JAYNE",
    "MiddleName": "LYNN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KERKHOFF",
    "OtherFirstName": "JAYNE",
    "OtherMiddleName": "LYNN",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "PT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "912 N MEMORIAL DR",
    "SecondLineMailingAddress": "PO BOX 710",
    "MailingAddressCityName": "MERRILL",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54452-3164",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "715-539-2510",
    "MailingAddressFaxNumber": "715-536-6146",
    "FirstLinePracticeLocationAddress": "304 KAPHAEM RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TOMAHAWK",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54487-7800",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "715-453-2141",
    "PracticeLocationAddressFaxNumber": "715-459-7519",
    "EnumerationDate": "03/10/2009",
    "LastUpdateDate": "03/10/2009",
    "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": "1052-024",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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