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1699552877 NPI number — KACEY JO O'BRENNAN DPT

NPI Number: 1699552877
Health Care Provider/Practitioner: KACEY JO O'BRENNAN DPT

Information about “1699552877” NPI (KACEY JO O'BRENNAN DPT) exists in 1699552877 in HTML format HTML  |  1699552877 in plain Text format TXT  |  1699552877 in PDF (Portable Document Format) PDF  |  1699552877 in an XML format XML  formats.

NPI Number : 1699552877 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1699552877",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "O'BRENNAN",
    "FirstName": "KACEY",
    "MiddleName": "JO",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HOTTES",
    "OtherFirstName": "KACEY",
    "OtherMiddleName": "JO",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "DPT",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "2001 BUTTERFIELD RD STE 1600",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DOWNERS GROVE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60515-1211",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "866-370-8206",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3611 NM 528 NW STE 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALBUQUERQUE",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "87114-8920",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "505-217-2826",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/12/2023",
    "LastUpdateDate": "08/06/2025",
    "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": "PTH12138",
          "LicenseNumberStateCode": "AL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "PT20250218",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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