{
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"EIN": null,
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"LastName": "KLEIN",
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"NameSuffix": null,
"Credential": "DPT",
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"OtherLastName": "KLEIN",
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"OtherCredential": "DPT",
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"FirstLineMailingAddress": "12516 83RD DR",
"SecondLineMailingAddress": "APT 5B",
"MailingAddressCityName": "KEW GARDENS",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11415-1902",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-331-9715",
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"FirstLinePracticeLocationAddress": "11937 METROPOLITAN AVE APT 5K",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KEW GARDENS",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-331-9715",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/26/2016",
"LastUpdateDate": "04/03/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
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"AuthorizedOfficialTitle": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "039772",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}