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1780013490 NPI number — JADA EXSTROM PT

NPI Number: 1780013490
Health Care Provider/Practitioner: JADA EXSTROM PT

Information about “1780013490” NPI (JADA EXSTROM PT) exists in 1780013490 in HTML format HTML  |  1780013490 in plain Text format TXT  |  1780013490 in PDF (Portable Document Format) PDF  |  1780013490 in an XML format XML  formats.

NPI Number : 1780013490 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780013490",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EXSTROM",
    "FirstName": "JADA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6170 FRANCISCAN DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LINCOLN",
    "MailingAddressStateName": "NE",
    "MailingAddressPostalCode": "68526-6006",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "402-430-3655",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3818 NORMAL BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LINCOLN",
    "PracticeLocationAddressStateName": "NE",
    "PracticeLocationAddressPostalCode": "68506-5240",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "402-488-4282",
    "PracticeLocationAddressFaxNumber": "402-488-6157",
    "EnumerationDate": "11/03/2013",
    "LastUpdateDate": "01/06/2014",
    "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": "9854",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "3148",
          "LicenseNumberStateCode": "NE",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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