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1942144720 NPI number — LIA LUCIA PEDERSEN

NPI Number: 1942144720
Health Care Provider/Practitioner: LIA LUCIA PEDERSEN

Information about “1942144720” NPI (LIA LUCIA PEDERSEN) exists in 1942144720 in HTML format HTML  |  1942144720 in plain Text format TXT  |  1942144720 in PDF (Portable Document Format) PDF  |  1942144720 in an XML format XML  formats.

NPI Number : 1942144720 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942144720",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PEDERSEN",
    "FirstName": "LIA",
    "MiddleName": "LUCIA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PEDERSEN",
    "OtherFirstName": "LIA",
    "OtherMiddleName": "LUCIA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "17 PARSON LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DURHAM",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06422-1317",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "860-538-7024",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "863 N MAIN STREET EXT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WALLINGFORD",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06492-2434",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-265-3280",
    "PracticeLocationAddressFaxNumber": "203-741-6569",
    "EnumerationDate": "04/14/2026",
    "LastUpdateDate": "04/14/2026",
    "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": "6082",
        "LicenseNumberStateCode": "CT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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