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1366409708 NPI number — PATRICIA PERRY BRUBAKER DPT

NPI Number: 1366409708
Health Care Provider/Practitioner: PATRICIA PERRY BRUBAKER DPT

Information about “1366409708” NPI (PATRICIA PERRY BRUBAKER DPT) exists in 1366409708 in HTML format HTML  |  1366409708 in plain Text format TXT  |  1366409708 in PDF (Portable Document Format) PDF  |  1366409708 in an XML format XML  formats.

NPI Number : 1366409708 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366409708",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRUBAKER",
    "FirstName": "PATRICIA",
    "MiddleName": "PERRY",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "NARRO",
    "OtherFirstName": "PATRICIA",
    "OtherMiddleName": "PERRY",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "MSPT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "245 LODGE TRL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FAYETTEVILLE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30215-7626",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-716-0358",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "245 LODGE TRL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAYETTEVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30215-7626",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-716-0358",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/28/2006",
    "LastUpdateDate": "06/16/2010",
    "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": "007154",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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