NPI Code Detail JSON Logo

1114791548 NPI number — JACKIE SUE MARCOTTE DPT, CLT-LANA

NPI Number: 1114791548
Health Care Provider/Practitioner: JACKIE SUE MARCOTTE DPT, CLT-LANA

Information about “1114791548” NPI (JACKIE SUE MARCOTTE DPT, CLT-LANA) exists in 1114791548 in HTML format HTML  |  1114791548 in plain Text format TXT  |  1114791548 in PDF (Portable Document Format) PDF  |  1114791548 in an XML format XML  formats.

NPI Number : 1114791548 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114791548",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MARCOTTE",
    "FirstName": "JACKIE",
    "MiddleName": "SUE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT, CLT-LANA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6196 KALENDA LN NE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALBERTVILLE",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55301-9652",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "612-418-6031",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1350 ST PETER AVENUE E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DELANO",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55328",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "763-452-9292",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/07/2023",
    "LastUpdateDate": "11/07/2023",
    "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": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "10969",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.