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1962463653 NPI number — RYAN LEE SCHALLENBERG PT, ATC

NPI Number: 1962463653
Health Care Provider/Practitioner: RYAN LEE SCHALLENBERG PT, ATC

Information about “1962463653” NPI (RYAN LEE SCHALLENBERG PT, ATC) exists in 1962463653 in HTML format HTML  |  1962463653 in plain Text format TXT  |  1962463653 in PDF (Portable Document Format) PDF  |  1962463653 in an XML format XML  formats.

NPI Number : 1962463653 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962463653",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SCHALLENBERG",
    "FirstName": "RYAN",
    "MiddleName": "LEE",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "PT, ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1025 S 6TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPRINGFIELD",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62703-2403",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "217-528-7541",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3020 S 6TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SPRINGFIELD",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62703-5915",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "217-528-7541",
    "PracticeLocationAddressFaxNumber": "217-789-2569",
    "EnumerationDate": "03/31/2006",
    "LastUpdateDate": "02/02/2021",
    "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": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "096001542",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "070014692",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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