{
"Npi": {
"NPI": "1386834638",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LA SALETTE HEALTH AND FITNESS INSTITUTE",
"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": "PO BOX 33265",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "INDIALANTIC",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32903-0265",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "321-525-5453",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "105 S RIVERSIDE DR",
"SecondLinePracticeLocationAddress": "STE # 150",
"PracticeLocationAddressCityName": "INDIALANTIC",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32903-4365",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "321-525-5453",
"PracticeLocationAddressFaxNumber": "866-810-9307",
"EnumerationDate": "08/01/2007",
"LastUpdateDate": "06/28/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CANO",
"AuthorizedOfficialFirstName": "MARIANNE",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.S.P.T.",
"AuthorizedOfficialTelephoneNumber": "321-525-5453",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": "PT-11017",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}