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1770203705 NPI number — DENALI BROOKE TARA DUFORD DPT

NPI Number: 1770203705
Health Care Provider/Practitioner: DENALI BROOKE TARA DUFORD DPT

Information about “1770203705” NPI (DENALI BROOKE TARA DUFORD DPT) exists in 1770203705 in HTML format HTML  |  1770203705 in plain Text format TXT  |  1770203705 in PDF (Portable Document Format) PDF  |  1770203705 in an XML format XML  formats.

NPI Number : 1770203705 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770203705",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DUFORD",
    "FirstName": "DENALI",
    "MiddleName": "BROOKE TARA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2001 BUTTERFIELD RD STE 1600",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DOWNERS GROVE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60515-1211",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "866-370-8206",
    "MailingAddressFaxNumber": "517-435-3670",
    "FirstLinePracticeLocationAddress": "200 OKATIE VILLAGE DR STE 105",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BLUFFTON",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29909-7526",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-706-2861",
    "PracticeLocationAddressFaxNumber": "843-706-2864",
    "EnumerationDate": "08/30/2022",
    "LastUpdateDate": "09/18/2025",
    "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": "CP034861T",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "CP018677T",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "PT61268007",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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