{
"Npi": {
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "INDIANA STATE UNIVERSITY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "567 N 5TH ST.",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TERRE HAUTE",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "47809",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "812-237-9613",
"MailingAddressFaxNumber": "812-237-9612",
"FirstLinePracticeLocationAddress": "567 N 5TH ST.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TERRE HAUTE",
"PracticeLocationAddressStateName": "IN",
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"PracticeLocationAddressTelephoneNumber": "812-237-9613",
"PracticeLocationAddressFaxNumber": "812-237-9612",
"EnumerationDate": "07/25/2007",
"LastUpdateDate": "04/11/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LUSTER",
"AuthorizedOfficialFirstName": "FRED",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "INTERIM PT DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "812-237-9613",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "05009329A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225100000X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}