{
"Npi": {
"NPI": "1356538821",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TREASURE COAST PEDORTHICS INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2686 US HIGHWAY 1",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VERO BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32960-5080",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "772-562-9045",
"MailingAddressFaxNumber": "772-562-9436",
"FirstLinePracticeLocationAddress": "2686 US HIGHWAY 1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "VERO BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32960-5080",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "772-562-9045",
"PracticeLocationAddressFaxNumber": "772-562-9436",
"EnumerationDate": "09/28/2007",
"LastUpdateDate": "12/07/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POWELL",
"AuthorizedOfficialFirstName": "ALTHEA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER / OPERATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "C.PED, L.PED",
"AuthorizedOfficialTelephoneNumber": "772-562-9045",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": "PED 78",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}