{
"Npi": {
"NPI": "1467989475",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MILESTONES CHILDREN'S THERAPY CENTER, 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": "111 E LAKE MARY BLVD STE 113",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANFORD",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32773-7111",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-203-9492",
"MailingAddressFaxNumber": "321-332-9768",
"FirstLinePracticeLocationAddress": "111 E LAKE MARY BLVD STE 113",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SANFORD",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32773-7111",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-203-9492",
"PracticeLocationAddressFaxNumber": "321-332-9768",
"EnumerationDate": "05/22/2017",
"LastUpdateDate": "05/25/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RAZURI",
"AuthorizedOfficialFirstName": "VIVIANA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BS/SLPA",
"AuthorizedOfficialTelephoneNumber": "407-203-9492",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}