{
"Npi": {
"NPI": "1679553200",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KONIOWSKY",
"FirstName": "LISA",
"MiddleName": "M",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PHYSICAL THERAPIST",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SHANNON",
"OtherFirstName": "LISA",
"OtherMiddleName": "M",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MPT",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 392573",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PITTSBURGH",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15251-9573",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "724-343-4060",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "77 W MCKINLEY WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "YOUNGSTOWN",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44514-1953",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "330-757-9772",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/19/2006",
"LastUpdateDate": "10/07/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT-010536",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}