{
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"OrgName": "MENDING MOUNTAINS THERAPY PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1345 ROCK CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CARBONDALE",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "81623-1893",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-581-2822",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1345 ROCK CT",
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"PracticeLocationAddressCityName": "CARBONDALE",
"PracticeLocationAddressStateName": "CO",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/20/2017",
"LastUpdateDate": "10/20/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BEERY",
"AuthorizedOfficialFirstName": "PATRICIA",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MRS.",
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"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "612-581-2822",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "8983",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}