{
"Npi": {
"NPI": "1275764920",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INTEGRATIVE PEDIATRIC THERAPY",
"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": "6101 WINDCOM COURT",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "PLANO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75093",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-608-0909",
"MailingAddressFaxNumber": "469-429-2065",
"FirstLinePracticeLocationAddress": "12840 HILLCREST ROAD",
"SecondLinePracticeLocationAddress": "SUITE E-104",
"PracticeLocationAddressCityName": "DALLAS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75230",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-404-3077",
"PracticeLocationAddressFaxNumber": "972-404-1124",
"EnumerationDate": "07/29/2009",
"LastUpdateDate": "03/25/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FRYER",
"AuthorizedOfficialFirstName": "SALLY",
"AuthorizedOfficialMiddleName": "N",
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT, CDT-D, SIPT CERT",
"AuthorizedOfficialTelephoneNumber": "972-404-3077",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "1066306",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}