1588695670 NPI number — ELIZABETH L MARR P.T., PH.D.,D.P.T.

NPI Number: 1588695670
Health Care Provider/Practitioner: ELIZABETH L MARR P.T., PH.D.,D.P.T.

NPI Number : 1588695670 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1588695670",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MARR",
    "FirstName": "ELIZABETH",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "P.T., PH.D.,D.P.T.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1760 MCCULLOCH BLVD N STE 200",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKE HAVASU CITY",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "86403-6559",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "285-055-6919",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1760 MCCULLOCH BLVD N STE 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAKE HAVASU CITY",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "86403-6559",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "285-055-6919",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/06/2006",
    "LastUpdateDate": "09/09/2020",
    "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": "2641",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "05012355A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}