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1578735916 NPI number — KELLY ELAINE THOMANN PT, DPT

NPI Number: 1578735916
Health Care Provider/Practitioner: KELLY ELAINE THOMANN PT, DPT

Information about “1578735916” NPI (KELLY ELAINE THOMANN PT, DPT) exists in 1578735916 in HTML format HTML  |  1578735916 in plain Text format TXT  |  1578735916 in PDF (Portable Document Format) PDF  |  1578735916 in an XML format XML  formats.

NPI Number : 1578735916 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578735916",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "THOMANN",
    "FirstName": "KELLY",
    "MiddleName": "ELAINE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PT, DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KEPLEY",
    "OtherFirstName": "KELLY",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "DPT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "790 REMINGTON BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOLINGBROOK",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60440-4909",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "630-296-2223",
    "MailingAddressFaxNumber": "630-759-9510",
    "FirstLinePracticeLocationAddress": "1301 W EVERGREEN AVE STE 1A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EFFINGHAM",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62401-1634",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "217-690-4882",
    "PracticeLocationAddressFaxNumber": "217-690-4883",
    "EnumerationDate": "03/26/2008",
    "LastUpdateDate": "06/04/2021",
    "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": "070016302",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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