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1548700065 NPI number — ANGEL LEE CLARKE LPTA

NPI Number: 1548700065
Health Care Provider/Practitioner: ANGEL LEE CLARKE LPTA

Information about “1548700065” NPI (ANGEL LEE CLARKE LPTA) exists in 1548700065 in HTML format HTML  |  1548700065 in plain Text format TXT  |  1548700065 in PDF (Portable Document Format) PDF  |  1548700065 in an XML format XML  formats.

NPI Number : 1548700065 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548700065",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CLARKE",
    "FirstName": "ANGEL",
    "MiddleName": "LEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LPTA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SALMON",
    "OtherFirstName": "ANGEL",
    "OtherMiddleName": "LEE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LPTA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "501 MONTGOMERY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RUTHER GLEN",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22546-1137",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "804-306-0698",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7015 CARNATION ST APT 214",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RICHMOND",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23225-5234",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "919-327-9666",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/02/2017",
    "LastUpdateDate": "03/02/2017",
    "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": "225200000X",
          "TaxonomyName": "Physical Therapy Assistant",
          "LicenseNumber": "2306604246",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": "0019004787",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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