{
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"OrgName": "GO KID GO THERAPY SERVICES, LLC",
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"FirstLineMailingAddress": "7 RALPH JUDD CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SUGAR GROVE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60554-4010",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-240-2962",
"MailingAddressFaxNumber": "630-405-1129",
"FirstLinePracticeLocationAddress": "131 FLINN STREET",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "BATAVIA",
"PracticeLocationAddressStateName": "IL",
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"EnumerationDate": "10/04/2016",
"LastUpdateDate": "10/26/2016",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOSUPAIT",
"AuthorizedOfficialFirstName": "LISA",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "P.T.",
"AuthorizedOfficialTelephoneNumber": "630-240-2962",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2251P0200X",
"TaxonomyName": "Pediatric Physical Therapist",
"LicenseNumber": "070012467",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}