{
"Npi": {
"NPI": "1295905321",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HOLLISTER 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": "6775 DUNNVILLE WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HOLLISTER",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95023-9241",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "831-636-3392",
"MailingAddressFaxNumber": "831-636-3393",
"FirstLinePracticeLocationAddress": "321 SAN FELIPE RD STE 16",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HOLLISTER",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95023-3035",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "831-636-3392",
"PracticeLocationAddressFaxNumber": "831-636-3393",
"EnumerationDate": "03/04/2008",
"LastUpdateDate": "02/23/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEWELLEN",
"AuthorizedOfficialFirstName": "ANNA",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "OWNER/PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MPT",
"AuthorizedOfficialTelephoneNumber": "831-636-3392",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "PT213640",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}