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1790319119 NPI number — THIRD PHASE MEDICAL, LLC DBA PHYSICAL THERAPY NOW, PINELLAS PARK

NPI Number: 1790319119
Health Care Provider/Practitioner: THIRD PHASE MEDICAL, LLC DBA PHYSICAL THERAPY NOW, PINELLAS PARK

Information about “1790319119” NPI (THIRD PHASE MEDICAL, LLC DBA PHYSICAL THERAPY NOW, PINELLAS PARK) exists in 1790319119 in HTML format HTML  |  1790319119 in plain Text format TXT  |  1790319119 in PDF (Portable Document Format) PDF  |  1790319119 in an XML format XML  formats.

NPI Number : 1790319119 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790319119",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "NEXT PHASE MEDICAL LLC",
    "ParentOrgTIN": null,
    "OrgName": "THIRD PHASE MEDICAL, LLC DBA PHYSICAL THERAPY NOW, PINELLAS PARK",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6709 49TH ST N",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PINELLAS PARK",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33781-5728",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "727-914-6343",
    "MailingAddressFaxNumber": "727-914-6341",
    "FirstLinePracticeLocationAddress": "6709 49TH ST N",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PINELLAS PARK",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33781-5728",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "727-914-6343",
    "PracticeLocationAddressFaxNumber": "727-914-6341",
    "EnumerationDate": "02/25/2020",
    "LastUpdateDate": "10/18/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WITTLES",
    "AuthorizedOfficialFirstName": "DEBRA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "727-275-7668",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208100000X",
        "TaxonomyName": "Physical Medicine & Rehabilitation Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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