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1083940225 NPI number — KETLY C THELUSMA RRT

NPI Number: 1083940225
Health Care Provider/Practitioner: KETLY C THELUSMA RRT

Information about “1083940225” NPI (KETLY C THELUSMA RRT) exists in 1083940225 in HTML format HTML  |  1083940225 in plain Text format TXT  |  1083940225 in PDF (Portable Document Format) PDF  |  1083940225 in an XML format XML  formats.

NPI Number : 1083940225 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083940225",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "THELUSMA",
    "FirstName": "KETLY",
    "MiddleName": "C",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RRT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "N/A",
    "OtherFirstName": "N/A",
    "OtherMiddleName": "N/A",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "N/A",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "2431 SW WEBSTER LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORT ST LUCIE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "34953-5753",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "772-240-4280",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2431 SW WEBSTER LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORT ST LUCIE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34953-5753",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "772-240-4280",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/22/2009",
    "LastUpdateDate": "10/22/2009",
    "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": "2279H0200X",
        "TaxonomyName": "Home Health Registered Respiratory Therapist",
        "LicenseNumber": "10007",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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