{
"Npi": {
"NPI": "1124239363",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DYNAMIC KIDS, INC.",
"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": "755 N PEACH AVE STE G14",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CLOVIS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93611-7247",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "559-433-4700",
"MailingAddressFaxNumber": "559-234-1440",
"FirstLinePracticeLocationAddress": "755 N PEACH AVE STE G14",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLOVIS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93611-7247",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "559-433-4700",
"PracticeLocationAddressFaxNumber": "559-234-1440",
"EnumerationDate": "05/26/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TIJERINA",
"AuthorizedOfficialFirstName": "AIMEE",
"AuthorizedOfficialMiddleName": "JAYNE",
"AuthorizedOfficialTitle": "DIRECTOR, PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "P.T.",
"AuthorizedOfficialTelephoneNumber": "559-433-4700",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "PT25969",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}