{
"Npi": {
"NPI": "1477826410",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "RANDLE",
"FirstName": "GRIFFITH",
"MiddleName": "JAMES",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DPT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2001 BUTTERFIELD RD STE 1600",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DOWNERS GROVE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60515-1211",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1321 RIVERSIDE PKWY",
"SecondLinePracticeLocationAddress": "STE A-2",
"PracticeLocationAddressCityName": "BELCAMP",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21017-1388",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "443-760-3971",
"PracticeLocationAddressFaxNumber": "410-272-4606",
"EnumerationDate": "02/22/2012",
"LastUpdateDate": "02/21/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "23953",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}