{
"Npi": {
"NPI": "1407066129",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADVANCED LYMPHEDEMA THERAPY SERVICES, LLC",
"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": "603 FERRIS LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DOYLESTOWN",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "18901-5037",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "215-913-0127",
"MailingAddressFaxNumber": "215-340-1299",
"FirstLinePracticeLocationAddress": "3 CORNER STONE DRIVE",
"SecondLinePracticeLocationAddress": "SUITE 700",
"PracticeLocationAddressCityName": "LANGHORNE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19047",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "215-750-0501",
"PracticeLocationAddressFaxNumber": "215-340-1299",
"EnumerationDate": "05/23/2007",
"LastUpdateDate": "07/10/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOSCHINEG",
"AuthorizedOfficialFirstName": "KIMBERLY",
"AuthorizedOfficialMiddleName": "ANNE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OTRL",
"AuthorizedOfficialTelephoneNumber": "215-913-0127",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0400X",
"TaxonomyName": "Rehabilitation Clinic/Center",
"LicenseNumber": "OC008082",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}