NPI Code Detail JSON Logo

1235508581 NPI number — SUSAN PETERSEN M.P.T

NPI Number: 1235508581
Health Care Provider/Practitioner: SUSAN PETERSEN M.P.T

Information about “1235508581” NPI (SUSAN PETERSEN M.P.T) exists in 1235508581 in HTML format HTML  |  1235508581 in plain Text format TXT  |  1235508581 in PDF (Portable Document Format) PDF  |  1235508581 in an XML format XML  formats.

NPI Number : 1235508581 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1235508581",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PETERSEN",
    "FirstName": "SUSAN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.P.T",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2012 PHALAROPE CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COSTA MESA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92626-4734",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "714-580-2868",
    "MailingAddressFaxNumber": "714-241-1007",
    "FirstLinePracticeLocationAddress": "2012 PHALAROPE CT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COSTA MESA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92626-4734",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "714-580-2868",
    "PracticeLocationAddressFaxNumber": "714-241-1007",
    "EnumerationDate": "09/16/2015",
    "LastUpdateDate": "09/16/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "18793",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.