{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "FENIX PHYSICAL THERAPY AND PERFORMANCE",
"LastName": null,
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"FirstLineMailingAddress": "10430 E GERMANN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MESA",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85212-9345",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "480-788-0399",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4365 E PECOS RD STE 136",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GILBERT",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85295-8053",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "480-788-0399",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/04/2017",
"LastUpdateDate": "01/22/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FAIR",
"AuthorizedOfficialFirstName": "AUSTIN",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "480-788-0399",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "10935",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}