{
"Npi": {
"NPI": "1295071090",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JOURNEY PHYSICAL THERAPY INC",
"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": "2754 N HAMPDEN CT",
"SecondLineMailingAddress": "UNIT 805",
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60614-1651",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "224-766-6346",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2250 W BELMONT AVE",
"SecondLinePracticeLocationAddress": "UNIT 1W",
"PracticeLocationAddressCityName": "CHICAGO",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60618-6561",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "773-883-2337",
"PracticeLocationAddressFaxNumber": "773-883-2336",
"EnumerationDate": "12/25/2012",
"LastUpdateDate": "08/12/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEE",
"AuthorizedOfficialFirstName": "PHILIP",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST/PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT, DPT, OCS",
"AuthorizedOfficialTelephoneNumber": "224-766-6346",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2251X0800X",
"TaxonomyName": "Orthopedic Physical Therapist",
"LicenseNumber": "070.017153",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}