1245442888 NPI number — SANDY BELLER CANOUT O.T.,P.T.,C.F.P.,CHT

NPI Number: 1245442888
Health Care Provider/Practitioner: SANDY BELLER CANOUT O.T.,P.T.,C.F.P.,CHT

NPI Number : 1245442888 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245442888",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CANOUT",
    "FirstName": "SANDY",
    "MiddleName": "BELLER",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "O.T.,P.T.,C.F.P.,CHT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3638 LEWIS AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LONG BEACH",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90807-4118",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "562-426-9797",
    "MailingAddressFaxNumber": "213-481-1518",
    "FirstLinePracticeLocationAddress": "1200 WILSHIRE BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 401",
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90017-1908",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "213-481-1515",
    "PracticeLocationAddressFaxNumber": "213-481-1518",
    "EnumerationDate": "05/04/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "174400000X",
          "TaxonomyName": "Specialist",
          "LicenseNumber": "PT12641",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "174400000X",
          "TaxonomyName": "Specialist",
          "LicenseNumber": "OT6574",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}