{
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"FirstLineMailingAddress": "PO BOX 706",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "IRON MOUNTAIN",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49801-0706",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "906-779-9487",
"MailingAddressFaxNumber": "906-828-1473",
"FirstLinePracticeLocationAddress": "221 E A ST",
"SecondLinePracticeLocationAddress": "SUITE C",
"PracticeLocationAddressCityName": "IRON MOUNTAIN",
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"PracticeLocationAddressFaxNumber": "906-828-1473",
"EnumerationDate": "05/05/2010",
"LastUpdateDate": "04/14/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SLEIK",
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"AuthorizedOfficialCredential": "PT, DPT, OCS, CEAS",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": "5501012214",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}