{
"Npi": {
"NPI": "1649754086",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WEBBER",
"FirstName": "JOHN",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": "JR.",
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2076 HWY 42 WEST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CLAYTON",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27520",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-763-1050",
"MailingAddressFaxNumber": "919-313-1276",
"FirstLinePracticeLocationAddress": "3A CANDLEWOOD HILL RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HIGGANUM",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06441-4202",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "860-345-2622",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/21/2018",
"LastUpdateDate": "11/21/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "14847",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}