{
"Npi": {
"NPI": "1245980341",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LIBERTY SPORTS & PHYSICAL THERAPY LLC",
"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": "501 PARK HILL DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FREDERICKSBURG",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22401-3377",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "540-372-6745",
"MailingAddressFaxNumber": "540-735-0138",
"FirstLinePracticeLocationAddress": "501 PARK HILL DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FREDERICKSBURG",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22401-3377",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "540-656-2786",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/24/2022",
"LastUpdateDate": "11/03/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHANCE",
"AuthorizedOfficialFirstName": "SHAWN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRACTICE ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "540-656-2786",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225XH1200X",
"TaxonomyName": "Hand Occupational Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2251X0800X",
"TaxonomyName": "Orthopedic Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"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."
}
]
}
}
}