{
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"OrgName": "CURRENT PHYSICAL THERAPY CALDWELL",
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"FirstLineMailingAddress": "119 S VALLEY DR STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NAMPA",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83686-2985",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-800-1619",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1906 FAIRVIEW AVE STE 120",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CALDWELL",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83605-5425",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-606-5384",
"PracticeLocationAddressFaxNumber": "208-600-0649",
"EnumerationDate": "05/15/2023",
"LastUpdateDate": "05/15/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARTLEY",
"AuthorizedOfficialFirstName": "NICHOLAS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PROVIDER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "541-212-0037",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}