NPI Code Detail JSON Logo

1558488361 NPI number — PEDIATRIC THERAPY CENTER

NPI Number: 1558488361
Health Care Provider/Practitioner: PEDIATRIC THERAPY CENTER

Information about “1558488361” NPI (PEDIATRIC THERAPY CENTER) exists in 1558488361 in HTML format HTML  |  1558488361 in plain Text format TXT  |  1558488361 in PDF (Portable Document Format) PDF  |  1558488361 in an XML format XML  formats.

NPI Number : 1558488361 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558488361",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PEDIATRIC THERAPY CENTER",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1940 BONITA DR. - UPSTAIRS",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "APTOS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95003",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "831-684-1804",
    "MailingAddressFaxNumber": "831-684-1826",
    "FirstLinePracticeLocationAddress": "1940 BONITA DR. - UPSTAIRS",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "APTOS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95003",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "831-684-1804",
    "PracticeLocationAddressFaxNumber": "831-684-1826",
    "EnumerationDate": "03/25/2007",
    "LastUpdateDate": "05/09/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ALLEN",
    "AuthorizedOfficialFirstName": "KERI",
    "AuthorizedOfficialMiddleName": "LYNN",
    "AuthorizedOfficialTitle": "DIRECTOR OF SERVICES- OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MOT, OTR/L",
    "AuthorizedOfficialTelephoneNumber": "831-684-1804",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225XP0200X",
          "TaxonomyName": "Pediatric Occupational Therapist",
          "LicenseNumber": "OT6062",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225XP0200X",
          "TaxonomyName": "Pediatric Occupational Therapist",
          "LicenseNumber": "OT7552",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "SP11200",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "SP12998",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "SP5343",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "PT29813",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225XP0200X",
          "TaxonomyName": "Pediatric Occupational Therapist",
          "LicenseNumber": "OT398",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225XP0200X",
          "TaxonomyName": "Pediatric Occupational Therapist",
          "LicenseNumber": "OT2656",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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