NPI Code Detail JSON Logo

1538540414 NPI number — MARSHA GILL OMT COM

NPI Number: 1538540414
Health Care Provider/Practitioner: MARSHA GILL OMT COM

Information about “1538540414” NPI (MARSHA GILL OMT COM) exists in 1538540414 in HTML format HTML  |  1538540414 in plain Text format TXT  |  1538540414 in PDF (Portable Document Format) PDF  |  1538540414 in an XML format XML  formats.

NPI Number : 1538540414 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1538540414",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GILL",
    "FirstName": "MARSHA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "OMT COM",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GILL",
    "OtherFirstName": "MARCI",
    "OtherMiddleName": "MARY",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "OMT COM",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "8447 W DESERT ELM LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PEORIA",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85383-3645",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "602-796-6070",
    "MailingAddressFaxNumber": "888-796-9570",
    "FirstLinePracticeLocationAddress": "14050 N 83RD AVE",
    "SecondLinePracticeLocationAddress": "SUITE 290",
    "PracticeLocationAddressCityName": "PEORIA",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85381-5638",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "602-796-6070",
    "PracticeLocationAddressFaxNumber": "888-796-9570",
    "EnumerationDate": "06/16/2015",
    "LastUpdateDate": "07/21/2022",
    "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": "125J00000X",
          "TaxonomyName": "Dental Therapist",
          "LicenseNumber": "554",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "125Q00000X",
          "TaxonomyName": "Oral Medicine Dentistry",
          "LicenseNumber": "554",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "174400000X",
          "TaxonomyName": "Specialist",
          "LicenseNumber": "554",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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