{
"Npi": {
"NPI": "1114239498",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STAFFORD PHYSICAL THERAPY, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 588",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GARRISONVILLE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22463-0588",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "540-659-6408",
"MailingAddressFaxNumber": "540-659-6445",
"FirstLinePracticeLocationAddress": "572 GARRISONVILLE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STAFFORD",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22554-3702",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "540-659-6408",
"PracticeLocationAddressFaxNumber": "540-659-6445",
"EnumerationDate": "07/02/2010",
"LastUpdateDate": "07/13/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HORRICKS",
"AuthorizedOfficialFirstName": "PETER",
"AuthorizedOfficialMiddleName": "JOHN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "540-659-6408",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "2305003039",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}