{
"Npi": {
"NPI": "1386790525",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INTEGRATED THERAPY SERVICES",
"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": "6013 RESTINGWAY LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RICHMOND",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23234-5565",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "804-275-4240",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "40 BROAD STREET RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MANAKIN SABOT",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23103-2213",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "804-784-3514",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/27/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALLEN",
"AuthorizedOfficialFirstName": "GERI",
"AuthorizedOfficialMiddleName": "P",
"AuthorizedOfficialTitle": "OCCUPATIONAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.T.",
"AuthorizedOfficialTelephoneNumber": "804-784-3514",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "0119000846",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}