{
"Npi": {
"NPI": "1063804185",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COLUMBIA REHABILITATION 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": "PO BOX 646",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLUMBIA",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39429-0646",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-444-9200",
"MailingAddressFaxNumber": "601-444-9090",
"FirstLinePracticeLocationAddress": "70 COLUMBIA PURVIS ROAD",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "COLUMBIA",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39429",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-444-9200",
"PracticeLocationAddressFaxNumber": "601-444-9090",
"EnumerationDate": "02/26/2015",
"LastUpdateDate": "09/08/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FREEMAN",
"AuthorizedOfficialFirstName": "JULIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "601-441-7182",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "PT4058",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}