{
"Npi": {
"NPI": "1295180453",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PETRUS 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": "406 AUSTIN OAKS CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEST MONROE",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "71292-2488",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "318-372-9732",
"MailingAddressFaxNumber": "318-388-8558",
"FirstLinePracticeLocationAddress": "1605 STUBBS AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MONROE",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "71201-5629",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "318-388-8414",
"PracticeLocationAddressFaxNumber": "318-388-8558",
"EnumerationDate": "04/25/2016",
"LastUpdateDate": "04/25/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PETRUS",
"AuthorizedOfficialFirstName": "WENDY",
"AuthorizedOfficialMiddleName": "NICOLE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.S.",
"AuthorizedOfficialTelephoneNumber": "318-372-9732",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0700X",
"TaxonomyName": "Hearing and Speech Clinic/Center",
"LicenseNumber": "5768",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}