NPI Code Detail JSON Logo

1417402272 NPI number — SARAH CVETA TELLER PT, DPT

NPI Number: 1417402272
Health Care Provider/Practitioner: SARAH CVETA TELLER PT, DPT

Information about “1417402272” NPI (SARAH CVETA TELLER PT, DPT) exists in 1417402272 in HTML format HTML  |  1417402272 in plain Text format TXT  |  1417402272 in PDF (Portable Document Format) PDF  |  1417402272 in an XML format XML  formats.

NPI Number : 1417402272 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417402272",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TELLER",
    "FirstName": "SARAH",
    "MiddleName": "CVETA",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PT, DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PAYICH",
    "OtherFirstName": "SARAH",
    "OtherMiddleName": "CVETA",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PT, DPT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2090 WOODWINDS DR STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WOODBURY",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55125-2522",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "651-968-5600",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2090 WOODWINDS DR STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WOODBURY",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55125",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-968-5600",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/22/2016",
    "LastUpdateDate": "06/12/2019",
    "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": "P16306",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "11376",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2025 Data Labs Health. All rights reserved.