{
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"LastName": null,
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"FirstLineMailingAddress": "1255 LAS TABLAS RD STE 201",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TEMPLETON",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93465-9750",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "805-286-4794",
"MailingAddressFaxNumber": "805-926-3176",
"FirstLinePracticeLocationAddress": "1255 LAS TABLAS RD STE 201",
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"PracticeLocationAddressCityName": "TEMPLETON",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "805-286-4794",
"PracticeLocationAddressFaxNumber": "805-926-3176",
"EnumerationDate": "04/18/2014",
"LastUpdateDate": "10/12/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HODGSON",
"AuthorizedOfficialFirstName": "STEVE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "805-286-4794",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": "28027",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"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."
}
}
}
}