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1417763640 NPI number — MATT KURILLA PTA

NPI Number: 1417763640
Health Care Provider/Practitioner: MATT KURILLA PTA

Information about “1417763640” NPI (MATT KURILLA PTA) exists in 1417763640 in HTML format HTML  |  1417763640 in plain Text format TXT  |  1417763640 in PDF (Portable Document Format) PDF  |  1417763640 in an XML format XML  formats.

NPI Number : 1417763640 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417763640",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KURILLA",
    "FirstName": "MATT",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PTA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8851 GOODRICH RD APT 213",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BLOOMINGTON",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55437-1624",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "608-445-2523",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3800 AMERICAN BLVD W # 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BLOOMINGTON",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55431-4420",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "952-831-8742",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/03/2024",
    "LastUpdateDate": "12/03/2024",
    "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": "225200000X",
        "TaxonomyName": "Physical Therapy Assistant",
        "LicenseNumber": "A3033",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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