{
"Npi": {
"NPI": "1578232542",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ENGEL",
"FirstName": "KAILA",
"MiddleName": "MARIE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DPT, PT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KIKUGAWA",
"OtherFirstName": "KAILA",
"OtherMiddleName": "MARIE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "DPT, PT",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "4920 30TH AVE S APT 118",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FARGO",
"MailingAddressStateName": "ND",
"MailingAddressPostalCode": "58104-9025",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-753-8004",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1420 9TH ST E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WEST FARGO",
"PracticeLocationAddressStateName": "ND",
"PracticeLocationAddressPostalCode": "58078-3381",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "701-364-2739",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/12/2021",
"LastUpdateDate": "10/14/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "4279",
"LicenseNumberStateCode": "NE",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "2793",
"LicenseNumberStateCode": "ND",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}