1831467893 NPI number — MICHAEL METHVIN M.ED., ATC, CSCS

NPI Number: 1831467893
Health Care Provider/Practitioner: MICHAEL METHVIN M.ED., ATC, CSCS

NPI Number : 1831467893 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1831467893",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "METHVIN",
    "FirstName": "MICHAEL",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.ED., ATC, CSCS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PSC 3 BOX 6046",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "APO",
    "MailingAddressStateName": "AP",
    "MailingAddressPostalCode": "96266-0061",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "108-466-8106",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "51 OSS/OHWS (PACAF) UNIT 2163",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "APO",
    "PracticeLocationAddressStateName": "AP",
    "PracticeLocationAddressPostalCode": "96278-2163",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "108-466-8106",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/06/2011",
    "LastUpdateDate": "08/23/2021",
    "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": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "AL3061",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "ATR-001492",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}