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1114719960 NPI number — MEREDITH MORGAN LUNDSTROM DPT

NPI Number: 1114719960
Health Care Provider/Practitioner: MEREDITH MORGAN LUNDSTROM DPT

Information about “1114719960” NPI (MEREDITH MORGAN LUNDSTROM DPT) exists in 1114719960 in HTML format HTML  |  1114719960 in plain Text format TXT  |  1114719960 in PDF (Portable Document Format) PDF  |  1114719960 in an XML format XML  formats.

NPI Number : 1114719960 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114719960",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LUNDSTROM",
    "FirstName": "MEREDITH",
    "MiddleName": "MORGAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MORGAN",
    "OtherFirstName": "MEREDITH",
    "OtherMiddleName": "BAILEY",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1991 FORDHAM DR STE 102",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FAYETTEVILLE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28304-3774",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "910-484-4653",
    "MailingAddressFaxNumber": "910-483-9256",
    "FirstLinePracticeLocationAddress": "1991 FORDHAM DR STE 102",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAYETTEVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28304-3774",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "910-484-4653",
    "PracticeLocationAddressFaxNumber": "910-483-9256",
    "EnumerationDate": "05/19/2025",
    "LastUpdateDate": "12/04/2025",
    "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": "P24042",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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