{
"Npi": {
"NPI": "1679511364",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SPECTRUM REHABILITATION AND WELLNESS INC.",
"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": "341 N MAITLAND AVE STE 290",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MAITLAND",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32751-4761",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "321-295-7170",
"MailingAddressFaxNumber": "321-697-7002",
"FirstLinePracticeLocationAddress": "341 N MAITLAND AVE STE 290",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MAITLAND",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32751-4761",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "321-295-7170",
"PracticeLocationAddressFaxNumber": "321-697-7002",
"EnumerationDate": "06/03/2006",
"LastUpdateDate": "03/26/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MEDINA",
"AuthorizedOfficialFirstName": "MANUEL",
"AuthorizedOfficialMiddleName": "VICENTE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "407-587-9580",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0401X",
"TaxonomyName": "Comprehensive Outpatient Rehabilitation Facility (CORF)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}