{
"Npi": {
"NPI": "1609015304",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AUTONOMY HEALTH INC",
"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": "1395 NW 95TH TER",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIAMI",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33147-2615",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-691-4360",
"MailingAddressFaxNumber": "305-835-0685",
"FirstLinePracticeLocationAddress": "1395 NW 95TH TER",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MIAMI",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33147-2615",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-691-4360",
"PracticeLocationAddressFaxNumber": "305-835-0685",
"EnumerationDate": "02/19/2009",
"LastUpdateDate": "02/19/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLERMONT",
"AuthorizedOfficialFirstName": "PIERRE",
"AuthorizedOfficialMiddleName": "PHILIPPE",
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MSPT",
"AuthorizedOfficialTelephoneNumber": "786-709-7268",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171W00000X",
"TaxonomyName": "Contractor",
"LicenseNumber": "PT13681",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}