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1497438212 NPI number — MAYA MARIE PRINCE DPT

NPI Number: 1497438212
Health Care Provider/Practitioner: MAYA MARIE PRINCE DPT

Information about “1497438212” NPI (MAYA MARIE PRINCE DPT) exists in 1497438212 in HTML format HTML  |  1497438212 in plain Text format TXT  |  1497438212 in PDF (Portable Document Format) PDF  |  1497438212 in an XML format XML  formats.

NPI Number : 1497438212 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497438212",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PRINCE",
    "FirstName": "MAYA",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2315 HIGHWAY K",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "O FALLON",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63368-8659",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "636-385-5277",
    "MailingAddressFaxNumber": "636-385-5277",
    "FirstLinePracticeLocationAddress": "140 LONG RD STE 201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHESTERFIELD",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63005-1282",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "636-265-1505",
    "PracticeLocationAddressFaxNumber": "636-266-2112",
    "EnumerationDate": "08/09/2023",
    "LastUpdateDate": "08/09/2023",
    "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": "2023004476",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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