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1265488753 NPI number — BARBARA MARIE VANDERWOUDE MSPT

NPI Number: 1265488753
Health Care Provider/Practitioner: BARBARA MARIE VANDERWOUDE MSPT

Information about “1265488753” NPI (BARBARA MARIE VANDERWOUDE MSPT) exists in 1265488753 in HTML format HTML  |  1265488753 in plain Text format TXT  |  1265488753 in PDF (Portable Document Format) PDF  |  1265488753 in an XML format XML  formats.

NPI Number : 1265488753 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265488753",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VANDERWOUDE",
    "FirstName": "BARBARA",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "NAZARKO",
    "OtherFirstName": "BARBARA",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MSPT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "790 REMINGTON BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOLINGBROOK",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60440-4909",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "181 DEANNA DR STE C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOWELL",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46356-2402",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "219-696-0988",
    "PracticeLocationAddressFaxNumber": "219-696-0989",
    "EnumerationDate": "05/26/2006",
    "LastUpdateDate": "10/18/2023",
    "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": "05004131A",
        "LicenseNumberStateCode": "IN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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