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1710130596 NPI number — MICHAEL JOSEPH KONETSKY PT, DPT, OCS

NPI Number: 1710130596
Health Care Provider/Practitioner: MICHAEL JOSEPH KONETSKY PT, DPT, OCS

Information about “1710130596” NPI (MICHAEL JOSEPH KONETSKY PT, DPT, OCS) exists in 1710130596 in HTML format HTML  |  1710130596 in plain Text format TXT  |  1710130596 in PDF (Portable Document Format) PDF  |  1710130596 in an XML format XML  formats.

NPI Number : 1710130596 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710130596",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KONETSKY",
    "FirstName": "MICHAEL",
    "MiddleName": "JOSEPH",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PT, DPT, OCS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3709 GOVERNOR YEARDLEY LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WILLIAMSBURG",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23185-1489",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "808-341-5423",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "USA MEDDAC FORT EUSTIS",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT EUSTIS",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23185",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-314-7640",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/24/2008",
    "LastUpdateDate": "12/29/2015",
    "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": "2251X0800X",
        "TaxonomyName": "Orthopedic Physical Therapist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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