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1528972494 NPI number — ID THERAPHY GROUP LLC

NPI Number: 1528972494
Health Care Provider/Practitioner: ID THERAPHY GROUP LLC

Information about “1528972494” NPI (ID THERAPHY GROUP LLC) exists in 1528972494 in HTML format HTML  |  1528972494 in plain Text format TXT  |  1528972494 in PDF (Portable Document Format) PDF  |  1528972494 in an XML format XML  formats.

NPI Number : 1528972494 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1528972494",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ID THERAPHY GROUP LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "40 CALLE GAVIOTA",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MANATI",
    "MailingAddressStateName": "PR",
    "MailingAddressPostalCode": "00674-9420",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "787-608-2831",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "CARR PR 149 KM 9.3 UNIDAD LOCAL 6 SECTOR CUCHILLAS",
    "SecondLinePracticeLocationAddress": "BO HATO VIEJO",
    "PracticeLocationAddressCityName": "MANATI",
    "PracticeLocationAddressStateName": "PR",
    "PracticeLocationAddressPostalCode": "00674",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "787-695-8223",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/29/2026",
    "LastUpdateDate": "09/29/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "QUINTERO",
    "AuthorizedOfficialFirstName": "TOMMY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "787-608-2831",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "NULL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "NULL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "NULL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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