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1639054893 NPI number — MATTHEW PETER HERMAN OSBORN DPT

NPI Number: 1639054893
Health Care Provider/Practitioner: MATTHEW PETER HERMAN OSBORN DPT

Information about “1639054893” NPI (MATTHEW PETER HERMAN OSBORN DPT) exists in 1639054893 in HTML format HTML  |  1639054893 in plain Text format TXT  |  1639054893 in PDF (Portable Document Format) PDF  |  1639054893 in an XML format XML  formats.

NPI Number : 1639054893 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639054893",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "OSBORN",
    "FirstName": "MATTHEW",
    "MiddleName": "PETER HERMAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "11225 ARDENCROFT DR S",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSONVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32246-0568",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "352-697-0533",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "630 E TWINCOURT TRL STE 110",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT AUGUSTINE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32095-9113",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-464-9761",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/07/2025",
    "LastUpdateDate": "08/08/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "PT43477",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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