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1588736243 NPI number — JENNIFER MARIE PETERS PT

NPI Number: 1588736243
Health Care Provider/Practitioner: JENNIFER MARIE PETERS PT

Information about “1588736243” NPI (JENNIFER MARIE PETERS PT) exists in 1588736243 in HTML format HTML  |  1588736243 in plain Text format TXT  |  1588736243 in PDF (Portable Document Format) PDF  |  1588736243 in an XML format XML  formats.

NPI Number : 1588736243 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1588736243",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PETERS",
    "FirstName": "JENNIFER",
    "MiddleName": "MARIE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PETERS",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "600 S ANDREASEN DR",
    "SecondLineMailingAddress": "STE C",
    "MailingAddressCityName": "ESCONDIDO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92029-1917",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "760-591-7750",
    "MailingAddressFaxNumber": "760-294-9813",
    "FirstLinePracticeLocationAddress": "2067 W VISTA WAY",
    "SecondLinePracticeLocationAddress": "STE 185",
    "PracticeLocationAddressCityName": "VISTA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92083-6031",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "760-631-5888",
    "PracticeLocationAddressFaxNumber": "760-631-5880",
    "EnumerationDate": "11/15/2006",
    "LastUpdateDate": "03/29/2010",
    "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": "6879",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "35751",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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