{
"Npi": {
"NPI": "1770628141",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BAKER PHYSICAL THERAPY CLINIC",
"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": "4971 GROOM RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BAKER",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70714-3145",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "225-775-7051",
"MailingAddressFaxNumber": "225-774-7244",
"FirstLinePracticeLocationAddress": "4971 GROOM RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BAKER",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "70714-3145",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "225-775-7051",
"PracticeLocationAddressFaxNumber": "225-774-7244",
"EnumerationDate": "02/21/2007",
"LastUpdateDate": "06/21/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCCULLOCH",
"AuthorizedOfficialFirstName": "JULIAN",
"AuthorizedOfficialMiddleName": "CRAIG",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "P.T.",
"AuthorizedOfficialTelephoneNumber": "225-775-7051",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0400X",
"TaxonomyName": "Rehabilitation Clinic/Center",
"LicenseNumber": "PT-0307",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}