{
"Npi": {
"NPI": "1306624069",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HYDE PHYSICAL 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": "323 E 2ND ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PANAMA CITY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32401-3230",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-238-0552",
"MailingAddressFaxNumber": "850-769-1166",
"FirstLinePracticeLocationAddress": "2250 HARRISON AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PANAMA CITY",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32405-4548",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "850-872-3715",
"PracticeLocationAddressFaxNumber": "850-769-1166",
"EnumerationDate": "09/14/2023",
"LastUpdateDate": "09/14/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HYDE",
"AuthorizedOfficialFirstName": "JEFFREY",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "850-238-0650",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}