{
"Npi": {
"NPI": "1518055722",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PT RPT INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1931 SABAL PALM DR",
"SecondLineMailingAddress": "APT 103",
"MailingAddressCityName": "DAVIE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33324",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-370-9700",
"MailingAddressFaxNumber": "954-370-9700",
"FirstLinePracticeLocationAddress": "1931 SABAL PALM DR",
"SecondLinePracticeLocationAddress": "APT. 103",
"PracticeLocationAddressCityName": "DAVIE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33324-5960",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-610-5620",
"PracticeLocationAddressFaxNumber": "954-370-9700",
"EnumerationDate": "10/11/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TANZER",
"AuthorizedOfficialFirstName": "PHYLLIS",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPT",
"AuthorizedOfficialTelephoneNumber": "954-370-9700",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT6667",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}