{
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"OrgName": "DYNAMIC THERAPY SOLUTIONS",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "4605 W IMPERIAL VIEW CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROCKLIN",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95677-4492",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "916-532-4899",
"MailingAddressFaxNumber": "916-625-0626",
"FirstLinePracticeLocationAddress": "135 WOODLAND AVE",
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"PracticeLocationAddressCityName": "WOODLAND",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "530-662-9674",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/10/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FITZPATRICK",
"AuthorizedOfficialFirstName": "SHAWN",
"AuthorizedOfficialMiddleName": "MIKEL",
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"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": "MPT",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT-23166",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}