{
"Npi": {
"NPI": "1679875447",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADVANCE THERAPY SERVICES LLC",
"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": "1290 PINNACLE POINT DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLLIERVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38017-1364",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "901-428-3445",
"MailingAddressFaxNumber": "901-854-9261",
"FirstLinePracticeLocationAddress": "2597 AVERY AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MEMPHIS",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "38112-4818",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "901-416-2700",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/29/2010",
"LastUpdateDate": "11/29/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALLEN",
"AuthorizedOfficialFirstName": "AMY",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "OCCUPATIONAL THERAPIST/OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OTR/L",
"AuthorizedOfficialTelephoneNumber": "901-428-3445",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "252Y00000X",
"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": "3164",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251300000X",
"TaxonomyName": "Local Education Agency (LEA)",
"LicenseNumber": "3164",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}