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1679045546 NPI number — LEANDRO MODENESE BASTOS PT DPT

NPI Number: 1679045546
Health Care Provider/Practitioner: LEANDRO MODENESE BASTOS PT DPT

Information about “1679045546” NPI (LEANDRO MODENESE BASTOS PT DPT) exists in 1679045546 in HTML format HTML  |  1679045546 in plain Text format TXT  |  1679045546 in PDF (Portable Document Format) PDF  |  1679045546 in an XML format XML  formats.

NPI Number : 1679045546 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679045546",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BASTOS",
    "FirstName": "LEANDRO",
    "MiddleName": "MODENESE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PT DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4915 W ROSEWOOD AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPOKANE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "99208-3740",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "562-212-8477",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12403 E 1ST AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SPOKANE VALLEY",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "99216-0702",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "509-370-7597",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/17/2018",
    "LastUpdateDate": "03/27/2025",
    "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": "296037",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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