{
"Npi": {
"NPI": "1346336245",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TRI-LAKES PHYSICAL THERAPY, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "307 CARPENTER DAM RD",
"SecondLineMailingAddress": "BLDG. L",
"MailingAddressCityName": "HOT SPRINGS",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "71901-8218",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "501-623-6353",
"MailingAddressFaxNumber": "501-321-4783",
"FirstLinePracticeLocationAddress": "307 CARPENTER DAM ROAD",
"SecondLinePracticeLocationAddress": "BLDG. L",
"PracticeLocationAddressCityName": "HOT SPRINGS",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "71901-8218",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "501-623-6353",
"PracticeLocationAddressFaxNumber": "501-321-4783",
"EnumerationDate": "10/05/2006",
"LastUpdateDate": "03/22/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARDY",
"AuthorizedOfficialFirstName": "JON",
"AuthorizedOfficialMiddleName": "T",
"AuthorizedOfficialTitle": "OWNER / PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.P.T.",
"AuthorizedOfficialTelephoneNumber": "501-623-6353",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "PT 1481",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}