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1639425481 NPI number — MICHAEL EFREM GUBIEDA PTA

NPI Number: 1639425481
Health Care Provider/Practitioner: MICHAEL EFREM GUBIEDA PTA

Information about “1639425481” NPI (MICHAEL EFREM GUBIEDA PTA) exists in 1639425481 in HTML format HTML  |  1639425481 in plain Text format TXT  |  1639425481 in PDF (Portable Document Format) PDF  |  1639425481 in an XML format XML  formats.

NPI Number : 1639425481 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639425481",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GUBIEDA",
    "FirstName": "MICHAEL",
    "MiddleName": "EFREM",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PTA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10941 NW 59TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DORAL",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33178-2815",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "11870 W STATE ROAD 84",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAVIE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33325-3816",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-474-3611",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/31/2012",
    "LastUpdateDate": "04/18/2013",
    "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": "261QP2000X",
          "TaxonomyName": "Physical Therapy Clinic/Center",
          "LicenseNumber": "23459",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225200000X",
          "TaxonomyName": "Physical Therapy Assistant",
          "LicenseNumber": "23459",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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