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1962199307 NPI number — ARETAS02, LLC

NPI Number: 1962199307
Health Care Provider/Practitioner: ARETAS02, LLC

Information about “1962199307” NPI (ARETAS02, LLC) exists in 1962199307 in HTML format HTML  |  1962199307 in plain Text format TXT  |  1962199307 in PDF (Portable Document Format) PDF  |  1962199307 in an XML format XML  formats.

NPI Number : 1962199307 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962199307",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ARETAS02, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5764 S 108TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HALES CORNERS",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53130-1947",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5764 S 108TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HALES CORNERS",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53130-1947",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "480-543-8394",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/18/2023",
    "LastUpdateDate": "04/18/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ECKERT",
    "AuthorizedOfficialFirstName": "KEVIN",
    "AuthorizedOfficialMiddleName": "ROBERT",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DPT",
    "AuthorizedOfficialTelephoneNumber": "480-543-8394",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2251X0800X",
          "TaxonomyName": "Orthopedic Physical Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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