1356695944 NPI number — JUSTEN JOSEPH LOPEZ ATC, LAT, PES, GTS

NPI Number: 1356695944
Health Care Provider/Practitioner: JUSTEN JOSEPH LOPEZ ATC, LAT, PES, GTS

NPI Number : 1356695944 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1356695944",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LOPEZ",
    "FirstName": "JUSTEN",
    "MiddleName": "JOSEPH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ATC, LAT, PES, GTS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10 GLENVILLE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREENWICH",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06831-3680",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "518-258-9828",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10 GLENVILLE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GREENWICH",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06831-3680",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "518-258-9828",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/03/2012",
    "LastUpdateDate": "02/16/2023",
    "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": "246Z00000X",
          "TaxonomyName": "Other Specialist/Technologist",
          "LicenseNumber": "002612",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "AL 3159",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "1602",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}