{
"Npi": {
"NPI": "1053356907",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "REHABONE-CENTER FOR ORTHOPEDIC & SPORTS 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": "2037 DEVEERE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STERLING HEIGHTS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48310-5853",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "586-883-4176",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "37300 DEQUINDRE RD",
"SecondLinePracticeLocationAddress": "SUITE 300",
"PracticeLocationAddressCityName": "STERLING HEIGHTS",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48310-3591",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "586-983-2498",
"PracticeLocationAddressFaxNumber": "586-983-2501",
"EnumerationDate": "06/17/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LAQUI",
"AuthorizedOfficialFirstName": "GERVACIO",
"AuthorizedOfficialMiddleName": "MARASIGAN",
"AuthorizedOfficialTitle": "PRESIDENT CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MHSCPT,MTC,MGS",
"AuthorizedOfficialTelephoneNumber": "586-983-2498",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "5501007799",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}