1700334604 NPI number — NORTHRUP THERAPY

Table of content: (NPI 1700334604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700334604 NPI number — NORTHRUP THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHRUP THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700334604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21015 MARKET RIDGE
Provider Second Line Business Mailing Address:
STE. 101
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-4979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-833-4011
Provider Business Mailing Address Fax Number:
210-496-0101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21015 MARKET RIDGE
Provider Second Line Business Practice Location Address:
STE. 101
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-4979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-496-0100
Provider Business Practice Location Address Fax Number:
201-496-0101
Provider Enumeration Date:
09/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
NORTHRUP
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER, MANAGER
Authorized Official Telephone Number:
210-833-4011

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  61536 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 61536 . This is a "LICENSE PROFESSIONAL COUNSELOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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