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1215445549 NPI number — INTECORE WA, INC

NPI Number: 1215445549
Health Care Provider/Practitioner: INTECORE WA, INC

Information about “1215445549” NPI (INTECORE WA, INC) exists in 1215445549 in HTML format HTML  |  1215445549 in plain Text format TXT  |  1215445549 in PDF (Portable Document Format) PDF  |  1215445549 in an XML format XML  formats.

NPI Number : 1215445549 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215445549",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "INTECORE WA, INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5050 NE STATE WAY 303 #103-221",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BREMERTON",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98311",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-474-3274",
    "MailingAddressFaxNumber": "360-824-6720",
    "FirstLinePracticeLocationAddress": "1550 NE RIDDELL RD STE 170",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BREMERTON",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98310-3060",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-474-3274",
    "PracticeLocationAddressFaxNumber": "360-824-6720",
    "EnumerationDate": "01/22/2018",
    "LastUpdateDate": "01/15/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "VERTSON",
    "AuthorizedOfficialFirstName": "MARTIN",
    "AuthorizedOfficialMiddleName": "ANDREW",
    "AuthorizedOfficialTitle": "PRESIDENT/PHYSICAL THERAPIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "360-474-3274",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "60822534",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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