{
"Npi": {
"NPI": "1578821542",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROHEALTH THERAPY & SPORTS REHAB, PSC",
"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": "HC 03 BOX 29780",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AGUADA",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00602-9305",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-313-0829",
"MailingAddressFaxNumber": "787-200-8030",
"FirstLinePracticeLocationAddress": "BO GUAYABO CARR 115",
"SecondLinePracticeLocationAddress": "KM 20.6",
"PracticeLocationAddressCityName": "AGUADA",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00602-9305",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-313-0829",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/27/2012",
"LastUpdateDate": "08/13/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VAZQUEZ",
"AuthorizedOfficialFirstName": "JENIFFER",
"AuthorizedOfficialMiddleName": "MARI",
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "787-313-0829",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": "1374",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}