{
"Npi": {
"NPI": "1114950961",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LEWIS",
"FirstName": "GERALD",
"MiddleName": "E",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6800 SOUTHPOINT PKWY STE 300",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32216-8203",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-604-0640",
"MailingAddressFaxNumber": "904-634-0203",
"FirstLinePracticeLocationAddress": "1690 US HIGHWAY 1 S STE F",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ST AUGUSTINE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32084-6024",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-634-0640",
"PracticeLocationAddressFaxNumber": "904-634-0203",
"EnumerationDate": "07/07/2006",
"LastUpdateDate": "09/29/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "40QA00396700",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT40349",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}