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1235837352 NPI number — JUSTIN PANTALEON DPT

NPI Number: 1235837352
Health Care Provider/Practitioner: JUSTIN PANTALEON DPT

Information about “1235837352” NPI (JUSTIN PANTALEON DPT) exists in 1235837352 in HTML format HTML  |  1235837352 in plain Text format TXT  |  1235837352 in PDF (Portable Document Format) PDF  |  1235837352 in an XML format XML  formats.

NPI Number : 1235837352 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1235837352",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PANTALEON",
    "FirstName": "JUSTIN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2230 1/2 NORWALK AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOS ANGELES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90041-2902",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "323-388-8207",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2001 W ALAMEDA AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BURBANK",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91506-2932",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "818-953-4444",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/17/2023",
    "LastUpdateDate": "02/17/2023",
    "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": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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