{
"Npi": {
"NPI": "1265056154",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MOLOKAI PHYSICAL THERAPY & REHABILITATION 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": "PO BOX 398",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KAUNAKAKAI",
"MailingAddressStateName": "HI",
"MailingAddressPostalCode": "96748-0398",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-862-6787",
"MailingAddressFaxNumber": "808-762-1318",
"FirstLinePracticeLocationAddress": "109 ALA MALAMA ST UNIT A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KAUNAKAKAI",
"PracticeLocationAddressStateName": "HI",
"PracticeLocationAddressPostalCode": "96748",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "808-862-6787",
"PracticeLocationAddressFaxNumber": "808-762-1318",
"EnumerationDate": "06/05/2020",
"LastUpdateDate": "09/02/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CORREA",
"AuthorizedOfficialFirstName": "GENEVIEVE",
"AuthorizedOfficialMiddleName": "F",
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT, DPT",
"AuthorizedOfficialTelephoneNumber": "808-650-2339",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}