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1215752456 NPI number — JOHN ETHAN MENG DPT

NPI Number: 1215752456
Health Care Provider/Practitioner: JOHN ETHAN MENG DPT

Information about “1215752456” NPI (JOHN ETHAN MENG DPT) exists in 1215752456 in HTML format HTML  |  1215752456 in plain Text format TXT  |  1215752456 in PDF (Portable Document Format) PDF  |  1215752456 in an XML format XML  formats.

NPI Number : 1215752456 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215752456",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MENG",
    "FirstName": "JOHN",
    "MiddleName": "ETHAN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MENG",
    "OtherFirstName": "ETHAN",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "DPT",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "805 N 4TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WILMINGTON",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28401-3471",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "805 N 4TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WILMINGTON",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28401-3471",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "910-915-4888",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/21/2024",
    "LastUpdateDate": "11/21/2024",
    "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": "2251S0007X",
          "TaxonomyName": "Sports Physical Therapist",
          "LicenseNumber": "P23558",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "2251N0400X",
          "TaxonomyName": "Neurology Physical Therapist",
          "LicenseNumber": "P23558",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2251X0800X",
          "TaxonomyName": "Orthopedic Physical Therapist",
          "LicenseNumber": "P23558",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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