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1790903284 NPI number — SUSAN THERESE CHARLWOOD PT, MSW

NPI Number: 1790903284
Health Care Provider/Practitioner: SUSAN THERESE CHARLWOOD PT, MSW

Information about “1790903284” NPI (SUSAN THERESE CHARLWOOD PT, MSW) exists in 1790903284 in HTML format HTML  |  1790903284 in plain Text format TXT  |  1790903284 in PDF (Portable Document Format) PDF  |  1790903284 in an XML format XML  formats.

NPI Number : 1790903284 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790903284",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CHARLWOOD",
    "FirstName": "SUSAN",
    "MiddleName": "THERESE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PT, MSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BALKUN",
    "OtherFirstName": "SUSAN",
    "OtherMiddleName": "THERESE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "PT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "58 E KILLINGLY RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FOSTER",
    "MailingAddressStateName": "RI",
    "MailingAddressPostalCode": "02825-1428",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "401-647-2975",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "34 DANIELSON PIKE",
    "SecondLinePracticeLocationAddress": "SUITE D",
    "PracticeLocationAddressCityName": "NORTH SCITUATE",
    "PracticeLocationAddressStateName": "RI",
    "PracticeLocationAddressPostalCode": "02857-1802",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "401-647-4455",
    "PracticeLocationAddressFaxNumber": "401-647-4456",
    "EnumerationDate": "04/23/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "PT00157",
          "LicenseNumberStateCode": "RI",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "1602",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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