{
"Npi": {
"NPI": "1578592424",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "REDONDO ORTHOPEDIC PHYSICAL THERAPY",
"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": "520 N PROSPECT AVE STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "REDONDO BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90277-3033",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-376-9222",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "23133 HAWTHORNE BLVD STE 104",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TORRANCE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90505-3729",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-321-4056",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/02/2006",
"LastUpdateDate": "06/10/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TYSSEE",
"AuthorizedOfficialFirstName": "STEVE",
"AuthorizedOfficialMiddleName": "P",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT, ATC",
"AuthorizedOfficialTelephoneNumber": "310-376-9222",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "PT23254",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}