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1124873054 NPI number — RESILIENT PHYSICAL THERAPY AND WELLNESS, PLLC

NPI Number: 1124873054
Health Care Provider/Practitioner: RESILIENT PHYSICAL THERAPY AND WELLNESS, PLLC

Information about “1124873054” NPI (RESILIENT PHYSICAL THERAPY AND WELLNESS, PLLC) exists in 1124873054 in HTML format HTML  |  1124873054 in plain Text format TXT  |  1124873054 in PDF (Portable Document Format) PDF  |  1124873054 in an XML format XML  formats.

NPI Number : 1124873054 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124873054",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "RESILIENT PHYSICAL THERAPY AND WELLNESS, PLLC",
    "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": "1213 FALSTER CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALEXANDRIA",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22308-1808",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "315-591-1926",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1213 FALSTER CT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALEXANDRIA",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22308-1808",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "703-261-9947",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/23/2024",
    "LastUpdateDate": "04/23/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "OROURKE",
    "AuthorizedOfficialFirstName": "MONICA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER, PT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DPT",
    "AuthorizedOfficialTelephoneNumber": "703-261-9947",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251E00000X",
          "TaxonomyName": "Home Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QP2000X",
          "TaxonomyName": "Physical Therapy Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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