{
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "GOODMAN PHYSICAL THERAPY",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9854 NATIONAL BLVD # 437",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90034-2713",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-441-1102",
"MailingAddressFaxNumber": "310-441-1088",
"FirstLinePracticeLocationAddress": "2001 S BARRINGTON AVE",
"SecondLinePracticeLocationAddress": "SUITE 119",
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90025-5363",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-441-1102",
"PracticeLocationAddressFaxNumber": "310-441-1088",
"EnumerationDate": "11/15/2007",
"LastUpdateDate": "09/14/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOODMAN",
"AuthorizedOfficialFirstName": "DEENA",
"AuthorizedOfficialMiddleName": "POLL",
"AuthorizedOfficialTitle": "OWNER/P.T.",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "P.T.",
"AuthorizedOfficialTelephoneNumber": "310-441-1102",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "PT 18437",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
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"TaxonomyName": "Physical Therapist",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}