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1902104102 NPI number — KATARZYNA BALUTA P.T.

NPI Number: 1902104102
Health Care Provider/Practitioner: KATARZYNA BALUTA P.T.

Information about “1902104102” NPI (KATARZYNA BALUTA P.T.) exists in 1902104102 in HTML format HTML  |  1902104102 in plain Text format TXT  |  1902104102 in PDF (Portable Document Format) PDF  |  1902104102 in an XML format XML  formats.

NPI Number : 1902104102 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1902104102",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BALUTA",
    "FirstName": "KATARZYNA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "P.T.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LUCE",
    "OtherFirstName": "KATARZYNA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "200 1ST ST SW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROCHESTER",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55905-0001",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "608-785-0940",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "310 W MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SPARTA",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54656",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "608-269-1770",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/11/2011",
    "LastUpdateDate": "03/21/2024",
    "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": "5501015478",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "12264",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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