{
"Npi": {
"NPI": "1013206002",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SAWTOOTH PHYSICAL THERAPY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "235 FLUME ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOISE",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83712-6318",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7979 W RIFLEMAN ST STE 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOISE",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83704-9066",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-340-5099",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/31/2011",
"LastUpdateDate": "06/11/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MILLER",
"AuthorizedOfficialFirstName": "RONALD",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "PT MS OCS",
"AuthorizedOfficialTelephoneNumber": "208-340-5099",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "PT 1938",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}