1245413095 NPI number — JOEL ALLAN THOMPSON OPA-C, ATC, LAT

NPI Number: 1245413095
Health Care Provider/Practitioner: JOEL ALLAN THOMPSON OPA-C, ATC, LAT

NPI Number : 1245413095 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245413095",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "THOMPSON",
    "FirstName": "JOEL",
    "MiddleName": "ALLAN",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "OPA-C, ATC, LAT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5279 LEBANON RD.",
    "SecondLineMailingAddress": "SUITE 144 PMB 333",
    "MailingAddressCityName": "FRISCO",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75034",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "469-304-3501",
    "MailingAddressFaxNumber": "469-304-3501",
    "FirstLinePracticeLocationAddress": "5729 LEBANON RD.",
    "SecondLinePracticeLocationAddress": "SUITE 144 PMB 333",
    "PracticeLocationAddressCityName": "FRISCO",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75034",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "469-304-3501",
    "PracticeLocationAddressFaxNumber": "469-304-3501",
    "EnumerationDate": "12/14/2007",
    "LastUpdateDate": "06/06/2017",
    "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": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "ATH.200007",
          "LicenseNumberStateCode": "LA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "AT4419",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}