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1275704173 NPI number — JEFFERSON GARCIA GARROVILLAS PT

NPI Number: 1275704173
Health Care Provider/Practitioner: JEFFERSON GARCIA GARROVILLAS PT

Information about “1275704173” NPI (JEFFERSON GARCIA GARROVILLAS PT) exists in 1275704173 in HTML format HTML  |  1275704173 in plain Text format TXT  |  1275704173 in PDF (Portable Document Format) PDF  |  1275704173 in an XML format XML  formats.

NPI Number : 1275704173 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275704173",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GARROVILLAS",
    "FirstName": "JEFFERSON",
    "MiddleName": "GARCIA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "27 SCENIC DR APT P",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CROTON ON HUDSON",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10520-1821",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "646-479-9214",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "27 SCENIC DR APT P",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CROTON ON HUDSON",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10520-1821",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "646-479-9214",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/18/2008",
    "LastUpdateDate": "12/01/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "11/18/2022",
    "NPIReactivationDate": "12/01/2022",
    "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": "025551-1",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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