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1689932212 NPI number — ANDREA J CLEGG ATC

NPI Number: 1689932212
Health Care Provider/Practitioner: ANDREA J CLEGG ATC

Information about “1689932212” NPI (ANDREA J CLEGG ATC) exists in 1689932212 in HTML format HTML  |  1689932212 in plain Text format TXT  |  1689932212 in PDF (Portable Document Format) PDF  |  1689932212 in an XML format XML  formats.

NPI Number : 1689932212 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689932212",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CLEGG",
    "FirstName": "ANDREA",
    "MiddleName": "J",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "201 E GERMANTOWN PIKE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PLYMOUTH MEETING",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19462-1550",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "610-825-1500",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "201 E GERMANTOWN PIKE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PLYMOUTH MEETING",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "19462-1550",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "610-825-1500",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/02/2012",
    "LastUpdateDate": "05/02/2012",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "RT003249",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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