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1710261052 NPI number — JENNIFER H BROSSART PT

NPI Number: 1710261052
Health Care Provider/Practitioner: JENNIFER H BROSSART PT

Information about “1710261052” NPI (JENNIFER H BROSSART PT) exists in 1710261052 in HTML format HTML  |  1710261052 in plain Text format TXT  |  1710261052 in PDF (Portable Document Format) PDF  |  1710261052 in an XML format XML  formats.

NPI Number : 1710261052 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710261052",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROSSART",
    "FirstName": "JENNIFER",
    "MiddleName": "H",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LUNDE",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": "H",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PT/LATC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2975 HIGHWAY 2E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RUGBY",
    "MailingAddressStateName": "ND",
    "MailingAddressPostalCode": "58368",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "701-776-5261",
    "MailingAddressFaxNumber": "701-776-5448",
    "FirstLinePracticeLocationAddress": "2975 HIGHWAY 2E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RUGBY",
    "PracticeLocationAddressStateName": "ND",
    "PracticeLocationAddressPostalCode": "58368",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "701-776-5261",
    "PracticeLocationAddressFaxNumber": "701-776-5448",
    "EnumerationDate": "10/05/2011",
    "LastUpdateDate": "11/06/2024",
    "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": "1266",
        "LicenseNumberStateCode": "ND",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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