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1922263805 NPI number — TERRANCE MONTRAL EDWARDS PT, DPT

NPI Number: 1922263805
Health Care Provider/Practitioner: TERRANCE MONTRAL EDWARDS PT, DPT

Information about “1922263805” NPI (TERRANCE MONTRAL EDWARDS PT, DPT) exists in 1922263805 in HTML format HTML  |  1922263805 in plain Text format TXT  |  1922263805 in PDF (Portable Document Format) PDF  |  1922263805 in an XML format XML  formats.

NPI Number : 1922263805 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922263805",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EDWARDS",
    "FirstName": "TERRANCE",
    "MiddleName": "MONTRAL",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "PT, DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "301 W FERTITTA BLVD",
    "SecondLineMailingAddress": "STE 4",
    "MailingAddressCityName": "LEESVILLE",
    "MailingAddressStateName": "LA",
    "MailingAddressPostalCode": "71446-4666",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "337-238-9931",
    "MailingAddressFaxNumber": "337-239-0066",
    "FirstLinePracticeLocationAddress": "414 N PLANT AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PLANT CITY",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33563",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "813-707-9362",
    "PracticeLocationAddressFaxNumber": "813-757-9687",
    "EnumerationDate": "07/21/2008",
    "LastUpdateDate": "06/14/2018",
    "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": "07348",
          "LicenseNumberStateCode": "LA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "12476",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "27002",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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