{
"Npi": {
"NPI": "1740572148",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INFINITY REHAB 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": "2224 S 77 SUNSHINE STP",
"SecondLineMailingAddress": "STE 96 PMB#111",
"MailingAddressCityName": "HARLINGEN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78550",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "956-361-2300",
"MailingAddressFaxNumber": "956-361-2391",
"FirstLinePracticeLocationAddress": "115 N WILLIAMS ROAD",
"SecondLinePracticeLocationAddress": "STE. A",
"PracticeLocationAddressCityName": "SAN BENITO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78586",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "956-361-2300",
"PracticeLocationAddressFaxNumber": "956-361-2391",
"EnumerationDate": "05/04/2011",
"LastUpdateDate": "05/24/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VILLARREAL",
"AuthorizedOfficialFirstName": "PAULA",
"AuthorizedOfficialMiddleName": "DEGLEY",
"AuthorizedOfficialTitle": "OCCUPATIONAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OTR",
"AuthorizedOfficialTelephoneNumber": "956-361-2300",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225XP0200X",
"TaxonomyName": "Pediatric Occupational Therapist",
"LicenseNumber": "111706",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}