{
"Npi": {
"NPI": "1598100109",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROACTIVE SPINE & SPORTS 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": "2620 LARKSPUR LN STE T",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "REDDING",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "96002-1043",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "530-605-4422",
"MailingAddressFaxNumber": "530-722-4289",
"FirstLinePracticeLocationAddress": "2620 LARKSPUR LANE",
"SecondLinePracticeLocationAddress": "SUITE T",
"PracticeLocationAddressCityName": "REDDING",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "96002-1043",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "530-605-4422",
"PracticeLocationAddressFaxNumber": "530-722-4289",
"EnumerationDate": "05/09/2013",
"LastUpdateDate": "12/31/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LITTLE",
"AuthorizedOfficialFirstName": "DALE",
"AuthorizedOfficialMiddleName": "P.",
"AuthorizedOfficialTitle": "OWNER/CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "530-605-4422",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "39209",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}