1477894624 NPI number — ROBIN RYAN MARQUEZ MSPT, CWS, CLT, CIDN

NPI Number: 1477894624
Health Care Provider/Practitioner: ROBIN RYAN MARQUEZ MSPT, CWS, CLT, CIDN

NPI Number : 1477894624 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1477894624",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MARQUEZ",
    "FirstName": "ROBIN",
    "MiddleName": "RYAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSPT, CWS, CLT, CIDN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "148 LINDEN ST STE 103",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WELLESLEY",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02482-7915",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "798-263-0060",
    "MailingAddressFaxNumber": "781-459-0051",
    "FirstLinePracticeLocationAddress": "148 LINDEN ST STE 103",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WELLESLEY",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "02482-7915",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "798-263-0060",
    "PracticeLocationAddressFaxNumber": "781-459-0051",
    "EnumerationDate": "03/13/2013",
    "LastUpdateDate": "07/10/2025",
    "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": "12138",
        "LicenseNumberStateCode": "MA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}