NPI Code Detail JSON Logo

1639303779 NPI number — ELYSE MARIE SURETTE DPT

NPI Number: 1639303779
Health Care Provider/Practitioner: ELYSE MARIE SURETTE DPT

Information about “1639303779” NPI (ELYSE MARIE SURETTE DPT) exists in 1639303779 in HTML format HTML  |  1639303779 in plain Text format TXT  |  1639303779 in PDF (Portable Document Format) PDF  |  1639303779 in an XML format XML  formats.

NPI Number : 1639303779 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639303779",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SURETTE",
    "FirstName": "ELYSE",
    "MiddleName": "MARIE",
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "65-1230 MAMALAHOA HWY STE E11",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KAMUELA",
    "MailingAddressStateName": "HI",
    "MailingAddressPostalCode": "96743-7301",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "808-885-7131",
    "MailingAddressFaxNumber": "808-885-5926",
    "FirstLinePracticeLocationAddress": "65-1230 MAMALAHOA HWY STE E11",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KAMUELA",
    "PracticeLocationAddressStateName": "HI",
    "PracticeLocationAddressPostalCode": "96743-7301",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "808-885-7131",
    "PracticeLocationAddressFaxNumber": "808-885-5926",
    "EnumerationDate": "05/04/2009",
    "LastUpdateDate": "05/04/2009",
    "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": "2954",
        "LicenseNumberStateCode": "HI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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