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1497754832 NPI number — JACQUELINE SUZANNE ROOD PT

NPI Number: 1497754832
Health Care Provider/Practitioner: JACQUELINE SUZANNE ROOD PT

Information about “1497754832” NPI (JACQUELINE SUZANNE ROOD PT) exists in 1497754832 in HTML format HTML  |  1497754832 in plain Text format TXT  |  1497754832 in PDF (Portable Document Format) PDF  |  1497754832 in an XML format XML  formats.

NPI Number : 1497754832 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497754832",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROOD",
    "FirstName": "JACQUELINE",
    "MiddleName": "SUZANNE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCGEORGE",
    "OtherFirstName": "JACQUELINE",
    "OtherMiddleName": "SUZANNE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "PT",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "1203 FLYNN RD UNIT 160",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CAMARILLO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "93012-6203",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "805-804-4168",
    "MailingAddressFaxNumber": "805-830-1177",
    "FirstLinePracticeLocationAddress": "1855 COCHRAN ST STE 109",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SIMI VALLEY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "93065-2263",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "805-526-2311",
    "PracticeLocationAddressFaxNumber": "805-526-6608",
    "EnumerationDate": "07/19/2005",
    "LastUpdateDate": "07/14/2025",
    "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": "PT20566",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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