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1750507174 NPI number — GEMMARUTH R SAN PEDRO P.T.

NPI Number: 1750507174
Health Care Provider/Practitioner: GEMMARUTH R SAN PEDRO P.T.

Information about “1750507174” NPI (GEMMARUTH R SAN PEDRO P.T.) exists in 1750507174 in HTML format HTML  |  1750507174 in plain Text format TXT  |  1750507174 in PDF (Portable Document Format) PDF  |  1750507174 in an XML format XML  formats.

NPI Number : 1750507174 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750507174",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SAN PEDRO",
    "FirstName": "GEMMARUTH",
    "MiddleName": "R",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "P.T.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4508 LAUREL AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MCALLEN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78501-3759",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "956-534-0700",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1112 E GRIFFIN PKWY STE C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MISSION",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78572-2409",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "956-424-6946",
    "PracticeLocationAddressFaxNumber": "956-424-6957",
    "EnumerationDate": "04/17/2007",
    "LastUpdateDate": "09/07/2017",
    "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": "1084747",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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