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1336558758 NPI number — DEVIN MARIE PEMBERTON DPT

NPI Number: 1336558758
Health Care Provider/Practitioner: DEVIN MARIE PEMBERTON DPT

Information about “1336558758” NPI (DEVIN MARIE PEMBERTON DPT) exists in 1336558758 in HTML format HTML  |  1336558758 in plain Text format TXT  |  1336558758 in PDF (Portable Document Format) PDF  |  1336558758 in an XML format XML  formats.

NPI Number : 1336558758 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336558758",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PEMBERTON",
    "FirstName": "DEVIN",
    "MiddleName": "MARIE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HUGHEY",
    "OtherFirstName": "DEVIN",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "DPT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1302 PIAZZA DELLE PALLOTTOLE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOYNTON BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33426-8274",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "386-871-5288",
    "MailingAddressFaxNumber": "561-432-1075",
    "FirstLinePracticeLocationAddress": "6169 S JOG RD",
    "SecondLinePracticeLocationAddress": "SUITE A11",
    "PracticeLocationAddressCityName": "LAKE WORTH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33467-6579",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "561-432-0111",
    "PracticeLocationAddressFaxNumber": "561-432-1075",
    "EnumerationDate": "08/11/2014",
    "LastUpdateDate": "11/19/2015",
    "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": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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