NPI Code Detail JSON Logo

1891147237 NPI number — PROVIDENCE PHYSICAL MEDICINE PC

NPI Number: 1891147237
Health Care Provider/Practitioner: PROVIDENCE PHYSICAL MEDICINE PC

Information about “1891147237” NPI (PROVIDENCE PHYSICAL MEDICINE PC) exists in 1891147237 in HTML format HTML  |  1891147237 in plain Text format TXT  |  1891147237 in PDF (Portable Document Format) PDF  |  1891147237 in an XML format XML  formats.

NPI Number : 1891147237 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1891147237",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PROVIDENCE PHYSICAL MEDICINE PC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6911 SHANNON WILLOW RD",
    "SecondLineMailingAddress": "STE 500",
    "MailingAddressCityName": "CHARLOTTE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28226-1346",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-800-7414",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6911 SHANNON WILLOW RD",
    "SecondLinePracticeLocationAddress": "STE 500",
    "PracticeLocationAddressCityName": "CHARLOTTE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28226-1346",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-800-7414",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/11/2016",
    "LastUpdateDate": "07/11/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HYSER",
    "AuthorizedOfficialFirstName": "RACHEL",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OFFICE MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "704-620-8857",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208100000X",
        "TaxonomyName": "Physical Medicine & Rehabilitation Physician",
        "LicenseNumber": "2006-01409",
        "LicenseNumberStateCode": "NC",
        "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."
      }
    }
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.