{
"Npi": {
"NPI": "1184925604",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JOHNSON",
"FirstName": "CARLA",
"MiddleName": "RENEE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DPT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "TAYLOR",
"OtherFirstName": "CARLA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "2001 BUTTERFIELD RD STE 1600",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DOWNERS GROVE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60515-1211",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "866-370-8206",
"MailingAddressFaxNumber": "517-435-3670",
"FirstLinePracticeLocationAddress": "2327 FOREST DR STE D",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ANNAPOLIS",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21401-3865",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "443-782-7243",
"PracticeLocationAddressFaxNumber": "410-881-6514",
"EnumerationDate": "11/15/2010",
"LastUpdateDate": "01/21/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "38954",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "23462",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}