{
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"OrgName": "PEDIATRIC PHYSICAL THERAPY SERVICES PC",
"LastName": null,
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"FirstLineMailingAddress": "40 HIGH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIDDLEBURY",
"MailingAddressStateName": "VT",
"MailingAddressPostalCode": "05753-1209",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "802-388-1153",
"MailingAddressFaxNumber": "802-388-1153",
"FirstLinePracticeLocationAddress": "40 HIGH ST",
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"PracticeLocationAddressCityName": "MIDDLEBURY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "802-388-1153",
"PracticeLocationAddressFaxNumber": "802-388-1153",
"EnumerationDate": "07/17/2007",
"LastUpdateDate": "07/17/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KELLEY",
"AuthorizedOfficialFirstName": "KIM",
"AuthorizedOfficialMiddleName": "PERKINS",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT, MED.",
"AuthorizedOfficialTelephoneNumber": "802-388-1153",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2251P0200X",
"TaxonomyName": "Pediatric Physical Therapist",
"LicenseNumber": "040-0002043",
"LicenseNumberStateCode": "VT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}