{
"Npi": {
"NPI": "1669839460",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUPERIOR PERFORMANCE PHYSICAL THERAPY PC",
"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": "4695 MACARTHUR CT",
"SecondLineMailingAddress": "SUITE 1100",
"MailingAddressCityName": "NEWPORT BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92660-1882",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "949-423-6241",
"MailingAddressFaxNumber": "844-538-9597",
"FirstLinePracticeLocationAddress": "4695 MACARTHUR CT",
"SecondLinePracticeLocationAddress": "SUITE 1100",
"PracticeLocationAddressCityName": "NEWPORT BEACH",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92660-1882",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-423-6241",
"PracticeLocationAddressFaxNumber": "844-538-9597",
"EnumerationDate": "01/25/2016",
"LastUpdateDate": "10/03/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEMIRCI",
"AuthorizedOfficialFirstName": "HEATHER",
"AuthorizedOfficialMiddleName": "BRITANY WHITING",
"AuthorizedOfficialTitle": "FOUNDER AND CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT, FFMT, FAAOMPT",
"AuthorizedOfficialTelephoneNumber": "949-423-6241",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "43596",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}