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1609252055 NPI number — CONNOR DAVIS TROTT DPT

NPI Number: 1609252055
Health Care Provider/Practitioner: CONNOR DAVIS TROTT DPT

Information about “1609252055” NPI (CONNOR DAVIS TROTT DPT) exists in 1609252055 in HTML format HTML  |  1609252055 in plain Text format TXT  |  1609252055 in PDF (Portable Document Format) PDF  |  1609252055 in an XML format XML  formats.

NPI Number : 1609252055 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609252055",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TROTT",
    "FirstName": "CONNOR",
    "MiddleName": "DAVIS",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5650 BAIRD DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MEMPHIS",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38119-7117",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "828-506-3072",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8070 US HIGHWAY 64",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MEMPHIS",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38133-4068",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "901-266-3838",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/08/2015",
    "LastUpdateDate": "01/30/2019",
    "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": "11162",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "PT5707",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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