{
"Npi": {
"NPI": "1154865046",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CENTRUM PHYSICAL THERAPY PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1501 S CENTER RD",
"SecondLineMailingAddress": "BUILDING A",
"MailingAddressCityName": "BURTON",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48509-1731",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "810-715-7746",
"MailingAddressFaxNumber": "810-715-7716",
"FirstLinePracticeLocationAddress": "1501 S CENTER RD",
"SecondLinePracticeLocationAddress": "BUILDING A",
"PracticeLocationAddressCityName": "BURTON",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48509-1731",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "810-715-7746",
"PracticeLocationAddressFaxNumber": "810-715-7716",
"EnumerationDate": "12/12/2016",
"LastUpdateDate": "12/12/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROLFE",
"AuthorizedOfficialFirstName": "CHELSEA",
"AuthorizedOfficialMiddleName": "LEEANN",
"AuthorizedOfficialTitle": "BILLER",
"AuthorizedOfficialNamePrefix": "MS.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "810-715-7746",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "5501006027",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}