{
"Npi": {
"NPI": "1578784922",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "QUALITY CARE PHYSICAL THERAPY, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9460 REDHAWK BEND LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKELAND",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33810-2126",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "727-810-0173",
"MailingAddressFaxNumber": "863-858-9406",
"FirstLinePracticeLocationAddress": "9460 REDHAWK BEND LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAKELAND",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33810-2126",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "727-810-0173",
"PracticeLocationAddressFaxNumber": "863-815-1373",
"EnumerationDate": "05/02/2007",
"LastUpdateDate": "07/15/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VANO",
"AuthorizedOfficialFirstName": "AVITO",
"AuthorizedOfficialMiddleName": "VELOSO",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "727-810-0173",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "8065",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}