{
"Npi": {
"NPI": "1558500231",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THERABEAT, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9880 HICKORY FLAT HWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WOODSTOCK",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30188-3081",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-687-2542",
"MailingAddressFaxNumber": "770-783-5049",
"FirstLinePracticeLocationAddress": "310 PAPER TRAIL WAY",
"SecondLinePracticeLocationAddress": "SUITE 302",
"PracticeLocationAddressCityName": "CANTON",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30115-5203",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-345-2804",
"PracticeLocationAddressFaxNumber": "678-827-0927",
"EnumerationDate": "02/19/2009",
"LastUpdateDate": "03/31/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PUCKETT",
"AuthorizedOfficialFirstName": "JENNIFER",
"AuthorizedOfficialMiddleName": "WALKER",
"AuthorizedOfficialTitle": "MUSIC THERAPIST/DIRECTOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MT-BC, NMT",
"AuthorizedOfficialTelephoneNumber": "770-687-2542",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0400X",
"TaxonomyName": "Rehabilitation Clinic/Center",
"LicenseNumber": "07335",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}