{
"Npi": {
"NPI": "1013396829",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TAYLOR PHYSICAL THERAPY AND SPORTS HEALTH, 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": "PO BOX 1083",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TWINSBURG",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44087-9083",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "216-505-8500",
"MailingAddressFaxNumber": "216-586-3886",
"FirstLinePracticeLocationAddress": "4949 GALAXY PKWY",
"SecondLinePracticeLocationAddress": "SUITE S",
"PracticeLocationAddressCityName": "CLEVELAND",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44128-5970",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "216-505-8500",
"PracticeLocationAddressFaxNumber": "216-586-3886",
"EnumerationDate": "05/26/2015",
"LastUpdateDate": "03/02/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TAYLOR",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "MARCUS",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "216-505-8500",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "009537",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}