1346779519 NPI number — JAMES LOGAN DREW PT, DPT, MBA, TPI

NPI Number: 1346779519
Health Care Provider/Practitioner: JAMES LOGAN DREW PT, DPT, MBA, TPI

NPI Number : 1346779519 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346779519",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DREW",
    "FirstName": "JAMES",
    "MiddleName": "LOGAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PT, DPT, MBA, TPI",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 45",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOOKOUT MOUNTAIN",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37350-0045",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "731-313-0057",
    "MailingAddressFaxNumber": "423-558-0974",
    "FirstLinePracticeLocationAddress": "820 SCENIC HWY STE B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOOKOUT MOUNTAIN",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37350-1418",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "731-313-0057",
    "PracticeLocationAddressFaxNumber": "423-558-0974",
    "EnumerationDate": "06/09/2017",
    "LastUpdateDate": "08/19/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "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": "11318",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}