{
"Npi": {
"NPI": "1457659583",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "UP & MOVIN' PEDIATRIC PHYSICAL THERAPY PC",
"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": "17835 LUNA CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIVERSIDE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92504-9523",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-961-9152",
"MailingAddressFaxNumber": "951-776-8028",
"FirstLinePracticeLocationAddress": "6180 BROCKTON AVE",
"SecondLinePracticeLocationAddress": "SUITE 202",
"PracticeLocationAddressCityName": "RIVERSIDE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92506-2228",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-961-9152",
"PracticeLocationAddressFaxNumber": "951-776-8028",
"EnumerationDate": "03/15/2011",
"LastUpdateDate": "03/15/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SPICKELMIER",
"AuthorizedOfficialFirstName": "JANE",
"AuthorizedOfficialMiddleName": "LOREI",
"AuthorizedOfficialTitle": "SECRETARY/TREASURER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "951-961-9152",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "252Y00000X",
"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": "PJ3678C",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}