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1578570669 NPI number — MELISSA SUE BLOOMER DPT

NPI Number: 1578570669
Health Care Provider/Practitioner: MELISSA SUE BLOOMER DPT

Information about “1578570669” NPI (MELISSA SUE BLOOMER DPT) exists in 1578570669 in HTML format HTML  |  1578570669 in plain Text format TXT  |  1578570669 in PDF (Portable Document Format) PDF  |  1578570669 in an XML format XML  formats.

NPI Number : 1578570669 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578570669",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLOOMER",
    "FirstName": "MELISSA",
    "MiddleName": "SUE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILLIAMS",
    "OtherFirstName": "MELISSA",
    "OtherMiddleName": "SUE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3022 MAGNOLIA BND",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLOTTESVILLE",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22911-8295",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "434-989-5520",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3022 MAGNOLIA BND",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLOTTESVILLE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22911-8295",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "434-989-5520",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/01/2006",
    "LastUpdateDate": "01/05/2024",
    "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": "2305204458",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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