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1477672095 NPI number — JILL SUSANNE GIBSON P.T.

NPI Number: 1477672095
Health Care Provider/Practitioner: JILL SUSANNE GIBSON P.T.

Information about “1477672095” NPI (JILL SUSANNE GIBSON P.T.) exists in 1477672095 in HTML format HTML  |  1477672095 in plain Text format TXT  |  1477672095 in PDF (Portable Document Format) PDF  |  1477672095 in an XML format XML  formats.

NPI Number : 1477672095 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1477672095",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GIBSON",
    "FirstName": "JILL",
    "MiddleName": "SUSANNE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "P.T.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GIBSON",
    "OtherFirstName": "JILL",
    "OtherMiddleName": "SUSANNE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "P.T.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "6674 CORTE EDUARDO",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CARLSBAD",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92009-4566",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "805-931-4435",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1570 E 17TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SANTA ANA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92705-8502",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "714-834-1111",
    "PracticeLocationAddressFaxNumber": "714-972-0454",
    "EnumerationDate": "03/28/2007",
    "LastUpdateDate": "06/24/2014",
    "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": "PT36639",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "P14505",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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