{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "STEPH WHITE CLARK DPT LLC",
"LastName": null,
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"NamePrefix": null,
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"OtherLastName": null,
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"FirstLineMailingAddress": "917 GRANT AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MEDFORD",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97501-3407",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-817-2512",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "917 GRANT AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MEDFORD",
"PracticeLocationAddressStateName": "OR",
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"PracticeLocationAddressTelephoneNumber": "352-817-2512",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/30/2022",
"LastUpdateDate": "06/30/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLARK",
"AuthorizedOfficialFirstName": "STEPHANIE",
"AuthorizedOfficialMiddleName": "MARIE",
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"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "PT, DPT, OCS",
"AuthorizedOfficialTelephoneNumber": "352-817-2512",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}