{
"Npi": {
"NPI": "1568650612",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MAUKA PHYSICAL THERAPY, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1555",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MAKAWAO",
"MailingAddressStateName": "HI",
"MailingAddressPostalCode": "96768-1555",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-878-6739",
"MailingAddressFaxNumber": "808-572-2265",
"FirstLinePracticeLocationAddress": "333 NAELE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KULA",
"PracticeLocationAddressStateName": "HI",
"PracticeLocationAddressPostalCode": "96790-8750",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "808-878-6739",
"PracticeLocationAddressFaxNumber": "808-572-2265",
"EnumerationDate": "10/12/2007",
"LastUpdateDate": "10/12/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SMITHSON-HUTTO",
"AuthorizedOfficialFirstName": "MARY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER-PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS,RPT,ATC,LMT",
"AuthorizedOfficialTelephoneNumber": "808-878-6739",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "PT-801",
"LicenseNumberStateCode": "HI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}