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1891221958 NPI number — ANTHONY LOPEZ ATC

NPI Number: 1891221958
Health Care Provider/Practitioner: ANTHONY LOPEZ ATC

Information about “1891221958” NPI (ANTHONY LOPEZ ATC) exists in 1891221958 in HTML format HTML  |  1891221958 in plain Text format TXT  |  1891221958 in PDF (Portable Document Format) PDF  |  1891221958 in an XML format XML  formats.

NPI Number : 1891221958 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1891221958",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LOPEZ",
    "FirstName": "ANTHONY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LOPEZ",
    "OtherFirstName": "TONY",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "5750 ABBEY DR",
    "SecondLineMailingAddress": "APT 2C",
    "MailingAddressCityName": "LISLE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60532-2582",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "309-721-6705",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "14011 KENTON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CRESTWOOD",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60445-2252",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "219-794-4653",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/11/2017",
    "LastUpdateDate": "05/11/2017",
    "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": "405300000X",
        "TaxonomyName": "Prevention Professional",
        "LicenseNumber": "2000026450",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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