{
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JUMP START PHYSICAL THERAPY, INC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1 H F BROWN WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NATICK",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "01760-3889",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "508-647-1633",
"MailingAddressFaxNumber": "508-647-1634",
"FirstLinePracticeLocationAddress": "1 H F BROWN WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NATICK",
"PracticeLocationAddressStateName": "MA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "508-647-1633",
"PracticeLocationAddressFaxNumber": "508-647-1634",
"EnumerationDate": "07/28/2006",
"LastUpdateDate": "03/04/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CONNORS",
"AuthorizedOfficialFirstName": "DANIEL",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST/ OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT, MS, CSCS, USAW",
"AuthorizedOfficialTelephoneNumber": "508-647-1633",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "11437",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}