{
"Npi": {
"NPI": "1265250781",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PHYSIOTHERAPY WORKS, 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 4605",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WINTER PARK",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32793-4605",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-657-5029",
"MailingAddressFaxNumber": "407-657-6320",
"FirstLinePracticeLocationAddress": "4824 GRANDVIEW PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DAVENPORT",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33837-2301",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "863-808-1888",
"PracticeLocationAddressFaxNumber": "863-808-1888",
"EnumerationDate": "10/02/2024",
"LastUpdateDate": "10/02/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MASON",
"AuthorizedOfficialFirstName": "ERIC",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "407-657-5029",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}