NPI Code Detail JSON Logo

1255000758 NPI number — RACHEL M WALLISH PT, DPT

NPI Number: 1255000758
Health Care Provider/Practitioner: RACHEL M WALLISH PT, DPT

Information about “1255000758” NPI (RACHEL M WALLISH PT, DPT) exists in 1255000758 in HTML format HTML  |  1255000758 in plain Text format TXT  |  1255000758 in PDF (Portable Document Format) PDF  |  1255000758 in an XML format XML  formats.

NPI Number : 1255000758 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255000758",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALLISH",
    "FirstName": "RACHEL",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PT, DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KENDALL",
    "OtherFirstName": "RACHEL",
    "OtherMiddleName": "M",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PT, DPT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2122 YORK RD STE 300",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OAK BROOK",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60523-1925",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "630-575-1980",
    "MailingAddressFaxNumber": "630-928-5080",
    "FirstLinePracticeLocationAddress": "2619 SW 9TH ST STE 103",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DES MOINES",
    "PracticeLocationAddressStateName": "IA",
    "PracticeLocationAddressPostalCode": "50315-1910",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "515-953-6911",
    "PracticeLocationAddressFaxNumber": "515-953-6913",
    "EnumerationDate": "09/08/2021",
    "LastUpdateDate": "01/14/2022",
    "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": "109952",
        "LicenseNumberStateCode": "IA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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