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1659462893 NPI number — MODUPEOLA MOTOMORI AGBOOLA DPT

NPI Number: 1659462893
Health Care Provider/Practitioner: MODUPEOLA MOTOMORI AGBOOLA DPT

Information about “1659462893” NPI (MODUPEOLA MOTOMORI AGBOOLA DPT) exists in 1659462893 in HTML format HTML  |  1659462893 in plain Text format TXT  |  1659462893 in PDF (Portable Document Format) PDF  |  1659462893 in an XML format XML  formats.

NPI Number : 1659462893 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659462893",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "AGBOOLA",
    "FirstName": "MODUPEOLA",
    "MiddleName": "MOTOMORI",
    "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": "5717 COUNTRY VIEW LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FRISCO",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75034-4637",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "214-470-1899",
    "MailingAddressFaxNumber": "214-469-2717",
    "FirstLinePracticeLocationAddress": "5717 COUNTRY VIEW LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FRISCO",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75034-4637",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "214-470-1899",
    "PracticeLocationAddressFaxNumber": "214-469-2717",
    "EnumerationDate": "09/27/2006",
    "LastUpdateDate": "12/12/2008",
    "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": "19515",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "40QA00933200",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "1170710",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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