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1952694077 NPI number — PHILIP R MCCOMBS DPT

NPI Number: 1952694077
Health Care Provider/Practitioner: PHILIP R MCCOMBS DPT

Information about “1952694077” NPI (PHILIP R MCCOMBS DPT) exists in 1952694077 in HTML format HTML  |  1952694077 in plain Text format TXT  |  1952694077 in PDF (Portable Document Format) PDF  |  1952694077 in an XML format XML  formats.

NPI Number : 1952694077 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1952694077",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCCOMBS",
    "FirstName": "PHILIP",
    "MiddleName": "R",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "417 GRAND PARK DR",
    "SecondLineMailingAddress": "SUITE 103",
    "MailingAddressCityName": "PARKERSBURG",
    "MailingAddressStateName": "WV",
    "MailingAddressPostalCode": "26105-4049",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "304-834-3905",
    "MailingAddressFaxNumber": "304-917-4872",
    "FirstLinePracticeLocationAddress": "417 GRAND PARK DR",
    "SecondLinePracticeLocationAddress": "SUITE 103",
    "PracticeLocationAddressCityName": "PARKERSBURG",
    "PracticeLocationAddressStateName": "WV",
    "PracticeLocationAddressPostalCode": "26105-4049",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "304-834-3905",
    "PracticeLocationAddressFaxNumber": "304-917-4872",
    "EnumerationDate": "05/23/2011",
    "LastUpdateDate": "05/23/2011",
    "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": "002938",
        "LicenseNumberStateCode": "WV",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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