1912599408 NPI number — RANDALL ULANGCA PA-C, PT, DPT

NPI Number: 1912599408
Health Care Provider/Practitioner: RANDALL ULANGCA PA-C, PT, DPT

NPI Number : 1912599408 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912599408",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ULANGCA",
    "FirstName": "RANDALL",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C, PT, DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "729 TREASURY DR APT J",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAYTON",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45429-6238",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "720-357-5838",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "729 TREASURY DR APT J",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAYTON",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "45429-6238",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "720-357-5838",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/06/2021",
    "LastUpdateDate": "04/01/2024",
    "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": "PT018530",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "50.008467RX",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}