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1205591419 NPI number — JOHNSON FAMILY PHYSICAL THERAPY, LLC

NPI Number: 1205591419
Health Care Provider/Practitioner: JOHNSON FAMILY PHYSICAL THERAPY, LLC

Information about “1205591419” NPI (JOHNSON FAMILY PHYSICAL THERAPY, LLC) exists in 1205591419 in HTML format HTML  |  1205591419 in plain Text format TXT  |  1205591419 in PDF (Portable Document Format) PDF  |  1205591419 in an XML format XML  formats.

NPI Number : 1205591419 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205591419",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "JOHNSON FAMILY PHYSICAL THERAPY, LLC",
    "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": "538 YELLOWSTONE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CODY",
    "MailingAddressStateName": "WY",
    "MailingAddressPostalCode": "82414-9300",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "307-578-8123",
    "MailingAddressFaxNumber": "307-578-8121",
    "FirstLinePracticeLocationAddress": "538 YELLOWSTONE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CODY",
    "PracticeLocationAddressStateName": "WY",
    "PracticeLocationAddressPostalCode": "82414-9300",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "307-578-8123",
    "PracticeLocationAddressFaxNumber": "307-578-8121",
    "EnumerationDate": "11/02/2021",
    "LastUpdateDate": "11/12/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "JOHNSON",
    "AuthorizedOfficialFirstName": "JUDE",
    "AuthorizedOfficialMiddleName": "T.",
    "AuthorizedOfficialTitle": "DPT / CEO",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DPT",
    "AuthorizedOfficialTelephoneNumber": "307-578-8123",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QP2000X",
        "TaxonomyName": "Physical Therapy Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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