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1174609879 NPI number — THAYNE LYNDON BOSH DPT

NPI Number: 1174609879
Health Care Provider/Practitioner: THAYNE LYNDON BOSH DPT

Information about “1174609879” NPI (THAYNE LYNDON BOSH DPT) exists in 1174609879 in HTML format HTML  |  1174609879 in plain Text format TXT  |  1174609879 in PDF (Portable Document Format) PDF  |  1174609879 in an XML format XML  formats.

NPI Number : 1174609879 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174609879",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOSH",
    "FirstName": "THAYNE",
    "MiddleName": "LYNDON",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 3992",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SILVERDALE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98383-3992",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9621 RIDGETOP BLVD NW",
    "SecondLinePracticeLocationAddress": "SUITE #100",
    "PracticeLocationAddressCityName": "SILVERDALE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98383-8502",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-337-7662",
    "PracticeLocationAddressFaxNumber": "360-337-7300",
    "EnumerationDate": "10/27/2006",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "PT00009351",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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