{
"Npi": {
"NPI": "1003149030",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CYPRESS THERAPY AND REHABILITATION, LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "RR 3 BOX 46",
"SecondLineMailingAddress": "P.O. BOX 45",
"MailingAddressCityName": "CARROLLTON",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62016-9506",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "217-556-1225",
"MailingAddressFaxNumber": "214-942-3717",
"FirstLinePracticeLocationAddress": "RR 3 BOX 46",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CARROLLTON",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62016-9506",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "217-556-1225",
"PracticeLocationAddressFaxNumber": "214-942-3717",
"EnumerationDate": "09/09/2009",
"LastUpdateDate": "09/09/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HEINZ-NEWINGHAM",
"AuthorizedOfficialFirstName": "KATHY",
"AuthorizedOfficialMiddleName": "J.",
"AuthorizedOfficialTitle": "EXECUTIVE OFFICER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS CCC/SLP",
"AuthorizedOfficialTelephoneNumber": "217-556-1225",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "252Y00000X",
"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": "146005569",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}