{
"Npi": {
"NPI": "1659591568",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COBURN A. MARSTON, PT",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "101 S 11TH ST",
"SecondLineMailingAddress": "SUITE 3",
"MailingAddressCityName": "LEESBURG",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34748-5767",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-787-3609",
"MailingAddressFaxNumber": "352-314-8979",
"FirstLinePracticeLocationAddress": "101 S 11TH ST",
"SecondLinePracticeLocationAddress": "SUITE 3",
"PracticeLocationAddressCityName": "LEESBURG",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34748-5767",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "352-787-3609",
"PracticeLocationAddressFaxNumber": "352-314-8979",
"EnumerationDate": "04/26/2007",
"LastUpdateDate": "06/17/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARSTON",
"AuthorizedOfficialFirstName": "COBURN",
"AuthorizedOfficialMiddleName": "ARTHUR",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "352-787-3609",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "PT1647",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}