{
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"IsOrgSubpart": "N",
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"OrgName": "NORTHWEST RETURN TO WORK MT VERNON",
"LastName": null,
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"Credential": null,
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"FirstLineMailingAddress": "1600 ROOSEVELT AVE",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "MOUNT VERNON",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98273-2646",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "360-424-5215",
"MailingAddressFaxNumber": "360-424-4074",
"FirstLinePracticeLocationAddress": "1600 ROOSEVELT AVE",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "MOUNT VERNON",
"PracticeLocationAddressStateName": "WA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "360-424-5215",
"PracticeLocationAddressFaxNumber": "360-424-4074",
"EnumerationDate": "09/30/2014",
"LastUpdateDate": "09/30/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STANG",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "MS,PT",
"AuthorizedOfficialTelephoneNumber": "360-424-5215",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2251X0800X",
"TaxonomyName": "Orthopedic Physical Therapist",
"LicenseNumber": "PT00006201",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}