{
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"NPI": "1568950665",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TEAM 3 PHYSICAL THERAPY, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2101 SABLESHIRE WAY SE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CONYERS",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30013-6475",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "413-214-4963",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1227 GREEN ST SE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CONYERS",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30012-5409",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-313-5943",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/25/2018",
"LastUpdateDate": "11/08/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ST. LOUIS",
"AuthorizedOfficialFirstName": "HANNAH",
"AuthorizedOfficialMiddleName": "MICHELLE",
"AuthorizedOfficialTitle": "PHYSICAL THERAPY",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "413-214-4963",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "PT011238",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2251X0800X",
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}
]
},
"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."
}
}
}
}