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1962007096 NPI number — PHYLLIS V JORDAN LMT, RMP

NPI Number: 1962007096
Health Care Provider/Practitioner: PHYLLIS V JORDAN LMT, RMP

Information about “1962007096” NPI (PHYLLIS V JORDAN LMT, RMP) exists in 1962007096 in HTML format HTML  |  1962007096 in plain Text format TXT  |  1962007096 in PDF (Portable Document Format) PDF  |  1962007096 in an XML format XML  formats.

NPI Number : 1962007096 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962007096",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JORDAN",
    "FirstName": "PHYLLIS",
    "MiddleName": "V",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMT, RMP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "21 E A ST APT 1",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BRUNSWICK",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21716-1473",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "240-578-5958",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "263 W PATRICK ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FREDERICK",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21701-6910",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "301-388-5237",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/04/2020",
    "LastUpdateDate": "12/04/2020",
    "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": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": "0019015415",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": "R02519",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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