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1306124383 NPI number — KASANDRA L LICKTEIG DPT

NPI Number: 1306124383
Health Care Provider/Practitioner: KASANDRA L LICKTEIG DPT

Information about “1306124383” NPI (KASANDRA L LICKTEIG DPT) exists in 1306124383 in HTML format HTML  |  1306124383 in plain Text format TXT  |  1306124383 in PDF (Portable Document Format) PDF  |  1306124383 in an XML format XML  formats.

NPI Number : 1306124383 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306124383",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LICKTEIG",
    "FirstName": "KASANDRA",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "790 REMINGTON BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOLINGBROOK",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60440-4909",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "410 E 22ND ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FREMONT",
    "PracticeLocationAddressStateName": "NE",
    "PracticeLocationAddressPostalCode": "68025-2609",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "402-721-3908",
    "PracticeLocationAddressFaxNumber": "402-721-4047",
    "EnumerationDate": "07/25/2011",
    "LastUpdateDate": "06/21/2024",
    "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": "3023",
        "LicenseNumberStateCode": "NE",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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