{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MARIO ANZALONE, DPT LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4377 COMMERCIAL WAY",
"SecondLineMailingAddress": "PMB 111",
"MailingAddressCityName": "SPRING HILL",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34606-1963",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-684-6424",
"MailingAddressFaxNumber": "352-684-6423",
"FirstLinePracticeLocationAddress": "4212 COMMERCIAL WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SPRING HILL",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34606-2325",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "352-684-6424",
"PracticeLocationAddressFaxNumber": "352-684-6423",
"EnumerationDate": "07/06/2011",
"LastUpdateDate": "07/06/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ANZALONE",
"AuthorizedOfficialFirstName": "MARIO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "352-684-6424",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT26322",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}