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1407014566 NPI number — BREENA SUE HIRSCH PTA

NPI Number: 1407014566
Health Care Provider/Practitioner: BREENA SUE HIRSCH PTA

Information about “1407014566” NPI (BREENA SUE HIRSCH PTA) exists in 1407014566 in HTML format HTML  |  1407014566 in plain Text format TXT  |  1407014566 in PDF (Portable Document Format) PDF  |  1407014566 in an XML format XML  formats.

NPI Number : 1407014566 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407014566",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HIRSCH",
    "FirstName": "BREENA",
    "MiddleName": "SUE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PTA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "11104 184TH AVENUE PL E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BONNEY LAKE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98391-6044",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "253-862-4708",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "920 12TH AVE SE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PUYALLUP",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98372-4920",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "253-841-3422",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/27/2008",
    "LastUpdateDate": "05/27/2008",
    "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": "225200000X",
        "TaxonomyName": "Physical Therapy Assistant",
        "LicenseNumber": "1776",
        "LicenseNumberStateCode": "AK",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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