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1922154665 NPI number — TERESA DEGEORGE EVERS PT

NPI Number: 1922154665
Health Care Provider/Practitioner: TERESA DEGEORGE EVERS PT

Information about “1922154665” NPI (TERESA DEGEORGE EVERS PT) exists in 1922154665 in HTML format HTML  |  1922154665 in plain Text format TXT  |  1922154665 in PDF (Portable Document Format) PDF  |  1922154665 in an XML format XML  formats.

NPI Number : 1922154665 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922154665",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EVERS",
    "FirstName": "TERESA",
    "MiddleName": "DEGEORGE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DEGEORGE",
    "OtherFirstName": "TERESA",
    "OtherMiddleName": "LYN",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "PT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3409 RED BAY CREEK ROAD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBIA",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "65203",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "573-999-2438",
    "MailingAddressFaxNumber": "573-815-2990",
    "FirstLinePracticeLocationAddress": "1600 E BROADWAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBIA",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "65201-5844",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "573-815-3889",
    "PracticeLocationAddressFaxNumber": "573-815-2990",
    "EnumerationDate": "01/26/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "103528",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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