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1407013204 NPI number — RENATO B. ANONUEVO JR. PT

NPI Number: 1407013204
Health Care Provider/Practitioner: RENATO B. ANONUEVO JR. PT

Information about “1407013204” NPI (RENATO B. ANONUEVO JR. PT) exists in 1407013204 in HTML format HTML  |  1407013204 in plain Text format TXT  |  1407013204 in PDF (Portable Document Format) PDF  |  1407013204 in an XML format XML  formats.

NPI Number : 1407013204 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407013204",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ANONUEVO",
    "FirstName": "RENATO",
    "MiddleName": "B.",
    "NamePrefix": null,
    "NameSuffix": "JR.",
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "201 N MAYFAIR RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WAUWATOSA",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53226-4216",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "414-259-7275",
    "MailingAddressFaxNumber": "414-259-7515",
    "FirstLinePracticeLocationAddress": "201 N MAYFAIR RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WAUWATOSA",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53226-4216",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "414-259-7275",
    "PracticeLocationAddressFaxNumber": "414-259-7515",
    "EnumerationDate": "05/20/2008",
    "LastUpdateDate": "05/20/2008",
    "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": "2251X0800X",
        "TaxonomyName": "Orthopedic Physical Therapist",
        "LicenseNumber": "4623-024",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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