{
"Npi": {
"NPI": "1629492632",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INTERNATIONAL PHYSIOTHERAPY ASSOCIATES PROFESSIONAL CORPORATION",
"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": "1801 RED PHISTER DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AVON",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46123-7172",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "317-272-1383",
"MailingAddressFaxNumber": "317-272-1383",
"FirstLinePracticeLocationAddress": "3737 N MERIDIAN ST",
"SecondLinePracticeLocationAddress": "SUITE 210",
"PracticeLocationAddressCityName": "INDIANAPOLIS",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "46208-4348",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "317-672-9198",
"PracticeLocationAddressFaxNumber": "844-274-0371",
"EnumerationDate": "02/11/2014",
"LastUpdateDate": "12/31/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MUKONA",
"AuthorizedOfficialFirstName": "ADONIAH",
"AuthorizedOfficialMiddleName": "MAVURA",
"AuthorizedOfficialTitle": "PRESIDENT & OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHYSICAL THERAPIST",
"AuthorizedOfficialTelephoneNumber": "317-332-9552",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "53000125A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}