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1104225515 NPI number — JENNIFER WALLINE DPT

NPI Number: 1104225515
Health Care Provider/Practitioner: JENNIFER WALLINE DPT

Information about “1104225515” NPI (JENNIFER WALLINE DPT) exists in 1104225515 in HTML format HTML  |  1104225515 in plain Text format TXT  |  1104225515 in PDF (Portable Document Format) PDF  |  1104225515 in an XML format XML  formats.

NPI Number : 1104225515 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104225515",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALLINE",
    "FirstName": "JENNIFER",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BERLEY",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "DPT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4040 BRYCE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FLOWER MOUND",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75077-7038",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "940-241-1215",
    "MailingAddressFaxNumber": "940-455-2041",
    "FirstLinePracticeLocationAddress": "4040 BRYCE LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FLOWER MOUND",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75077-7038",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "940-241-1215",
    "PracticeLocationAddressFaxNumber": "940-455-2041",
    "EnumerationDate": "08/21/2014",
    "LastUpdateDate": "08/19/2024",
    "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": "10070",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "1353422",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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