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1659476729 NPI number — LUCINDA MOWITT BRADSHAW PT

NPI Number: 1659476729
Health Care Provider/Practitioner: LUCINDA MOWITT BRADSHAW PT

Information about “1659476729” NPI (LUCINDA MOWITT BRADSHAW PT) exists in 1659476729 in HTML format HTML  |  1659476729 in plain Text format TXT  |  1659476729 in PDF (Portable Document Format) PDF  |  1659476729 in an XML format XML  formats.

NPI Number : 1659476729 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659476729",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRADSHAW",
    "FirstName": "LUCINDA",
    "MiddleName": "MOWITT",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "EMERSON",
    "OtherFirstName": "LUCINDA",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "PT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2255 MYRTLE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EUREKA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95501-3387",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "707-445-1317",
    "MailingAddressFaxNumber": "707-443-8961",
    "FirstLinePracticeLocationAddress": "2255 MYRTLE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EUREKA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95501-3387",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "707-445-1317",
    "PracticeLocationAddressFaxNumber": "707-443-8961",
    "EnumerationDate": "09/14/2006",
    "LastUpdateDate": "07/09/2007",
    "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": "PT73560",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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