{
"Npi": {
"NPI": "1053585950",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "M & M PHYSICAL THERAPY INC.",
"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": "800 CORPORATE DR",
"SecondLineMailingAddress": "SUITE190",
"MailingAddressCityName": "LADERA RANCH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92694-1152",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "949-218-0790",
"MailingAddressFaxNumber": "949-218-0791",
"FirstLinePracticeLocationAddress": "800 CORPORATE DR",
"SecondLinePracticeLocationAddress": "SUITE190",
"PracticeLocationAddressCityName": "LADERA RANCH",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92694-1152",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-218-0790",
"PracticeLocationAddressFaxNumber": "949-218-0791",
"EnumerationDate": "04/22/2008",
"LastUpdateDate": "09/09/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MONNAHAN",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "SPENCER",
"AuthorizedOfficialTitle": "PRESIDENT/ PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "P.T.",
"AuthorizedOfficialTelephoneNumber": "949-218-0790",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT16943",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}