{
"Npi": {
"NPI": "1710313978",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BROEDLING",
"FirstName": "CORI",
"MiddleName": "DIANE",
"NamePrefix": "MISS",
"NameSuffix": null,
"Credential": "MT, PTA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5065 MALABAR BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MELBOURNE BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32951-3257",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "720-635-4127",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3033 SARNO RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MELBOURNE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32934-7229",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "321-610-8979",
"PracticeLocationAddressFaxNumber": "321-610-8980",
"EnumerationDate": "09/19/2013",
"LastUpdateDate": "01/10/2017",
"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": "225200000X",
"TaxonomyName": "Physical Therapy Assistant",
"LicenseNumber": "PTA25013",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "172V00000X",
"TaxonomyName": "Community Health Worker",
"LicenseNumber": "MT0008418",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}