{
"Npi": {
"NPI": "1053864413",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DOVE PHYSICAL THERAPY, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3403 S PERRY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MONTGOMERY",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36105-2206",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "334-649-2699",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "445 DEXTER AVE",
"SecondLinePracticeLocationAddress": "SUITE 4050",
"PracticeLocationAddressCityName": "MONTGOMERY",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "36104-3775",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "334-549-4231",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/02/2016",
"LastUpdateDate": "11/29/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARTER",
"AuthorizedOfficialFirstName": "CLEVE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": "DPT, CSCS, CLT, CNDT",
"AuthorizedOfficialTelephoneNumber": "334-549-4231",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "PTH6421",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}