{
"Npi": {
"NPI": "1316367915",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PREMIER HOME 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": "3146 CROWNVIEW DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RANCHO PALOS VERDES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90275-6414",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-918-0765",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1300 W 6TH ST",
"SecondLinePracticeLocationAddress": "SUITE 3",
"PracticeLocationAddressCityName": "SAN PEDRO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90732-3531",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-519-1030",
"PracticeLocationAddressFaxNumber": "310-519-0194",
"EnumerationDate": "04/22/2014",
"LastUpdateDate": "04/22/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BERKOVICH",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "ANTHONY",
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "310-918-0765",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "PT26104",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}