NPI Code Detail JSON Logo

1801142914 NPI number — JEREMY SOLO CAGOCO LIWASAN P.T.

NPI Number: 1801142914
Health Care Provider/Practitioner: JEREMY SOLO CAGOCO LIWASAN P.T.

Information about “1801142914” NPI (JEREMY SOLO CAGOCO LIWASAN P.T.) exists in 1801142914 in HTML format HTML  |  1801142914 in plain Text format TXT  |  1801142914 in PDF (Portable Document Format) PDF  |  1801142914 in an XML format XML  formats.

NPI Number : 1801142914 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1801142914",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LIWASAN",
    "FirstName": "JEREMY SOLO",
    "MiddleName": "CAGOCO",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "P.T.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16089 POPPYSEED CIR UNIT 2008",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DELRAY BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33484-6314",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "716-867-2006",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7580 OMNI LN APT 201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT MYERS",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33905-5481",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "716-867-2006",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/25/2012",
    "LastUpdateDate": "07/25/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "PT25182",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "070017602",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "029263",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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