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1306480165 NPI number — MARY-GRACE MORALES PT, DPT

NPI Number: 1306480165
Health Care Provider/Practitioner: MARY-GRACE MORALES PT, DPT

Information about “1306480165” NPI (MARY-GRACE MORALES PT, DPT) exists in 1306480165 in HTML format HTML  |  1306480165 in plain Text format TXT  |  1306480165 in PDF (Portable Document Format) PDF  |  1306480165 in an XML format XML  formats.

NPI Number : 1306480165 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306480165",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MORALES",
    "FirstName": "MARY-GRACE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PT, DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2050 NEWNAN CROSSING BLVD E",
    "SecondLineMailingAddress": "APARTMENT 5101",
    "MailingAddressCityName": "NEWNAN",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30265",
    "MailingAddressCountryCode": "UM",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "120 SPRING ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEWNAN",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30263-2824",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "912-722-7168",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/04/2019",
    "LastUpdateDate": "11/04/2019",
    "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": "PT012146",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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