{
"Npi": {
"NPI": "1043528763",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AWARE PHYSICAL THERAPY,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": "2803 LYNDHURST AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WINSTON SALEM",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27103-4109",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-768-4248",
"MailingAddressFaxNumber": "336-768-4250",
"FirstLinePracticeLocationAddress": "2803 LYNDHURST AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WINSTON SALEM",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27103-4109",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-768-4248",
"PracticeLocationAddressFaxNumber": "336-768-4250",
"EnumerationDate": "09/15/2010",
"LastUpdateDate": "11/23/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ZOUBEK",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "ALLEN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MPT",
"AuthorizedOfficialTelephoneNumber": "336-768-4248",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "273Y00000X",
"TaxonomyName": "Rehabilitation Hospital Unit",
"LicenseNumber": "P9629",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}