{
"Npi": {
"NPI": "1134693757",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "OPTIMUM DPT, PLC",
"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": "614 WOODLAND AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PETOSKEY",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49770-8363",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "231-881-9770",
"MailingAddressFaxNumber": "231-881-9780",
"FirstLinePracticeLocationAddress": "2810 CHARLEVOIX RD STE 105",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PETOSKEY",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49770-8421",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "231-881-9770",
"PracticeLocationAddressFaxNumber": "231-881-9780",
"EnumerationDate": "01/16/2019",
"LastUpdateDate": "01/16/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GAUNT",
"AuthorizedOfficialFirstName": "MATTHEW",
"AuthorizedOfficialMiddleName": "T",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "231-881-9770",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}