{
"Npi": {
"NPI": "1750362471",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FAATZ, INC",
"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": "210 E CENTRAL AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WINTER HAVEN",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33880-6311",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "863-291-3000",
"MailingAddressFaxNumber": "863-293-7004",
"FirstLinePracticeLocationAddress": "210 E CENTRAL AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WINTER HAVEN",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33880-6311",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "863-291-3000",
"PracticeLocationAddressFaxNumber": "863-293-7004",
"EnumerationDate": "11/09/2005",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WOOLEY",
"AuthorizedOfficialFirstName": "BRUCE",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PROSTHETIST",
"AuthorizedOfficialTelephoneNumber": "863-682-1040",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": "PRO36,PRO60,ORT91",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}