NPI Code Detail JSON Logo

1124383377 NPI number — BULLDOG PHYISICAL THERAPY AND SPORTS MEDICINE

NPI Number: 1124383377
Health Care Provider/Practitioner: BULLDOG PHYISICAL THERAPY AND SPORTS MEDICINE

Information about “1124383377” NPI (BULLDOG PHYISICAL THERAPY AND SPORTS MEDICINE) exists in 1124383377 in HTML format HTML  |  1124383377 in plain Text format TXT  |  1124383377 in PDF (Portable Document Format) PDF  |  1124383377 in an XML format XML  formats.

NPI Number : 1124383377 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124383377",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BULLDOG PHYISICAL THERAPY AND SPORTS MEDICINE",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "500 RUSSELL ST",
    "SecondLineMailingAddress": "32",
    "MailingAddressCityName": "STARKVILLE",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "39759-3413",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "662-418-4675",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "500 RUSSELL ST",
    "SecondLinePracticeLocationAddress": "32",
    "PracticeLocationAddressCityName": "STARKVILLE",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39759-3413",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "662-418-4675",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/12/2012",
    "LastUpdateDate": "07/12/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BENNETT",
    "AuthorizedOfficialFirstName": "JODY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "662-418-4675",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2081S0010X",
        "TaxonomyName": "Sports Medicine (Physical Medicine & Rehabilitation) Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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