{
"Npi": {
"NPI": "1780294504",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BOWEN",
"FirstName": "AMI",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PT, DPT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MILLIGAN",
"OtherFirstName": "AMI",
"OtherMiddleName": "JO",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "4606 CLYDE MORRIS BLVD",
"SecondLineMailingAddress": "STE 1D",
"MailingAddressCityName": "PORT ORANGE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32129-7453",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5969 N CANTON CENTER RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CANTON",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48187-2757",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "877-407-3422",
"PracticeLocationAddressFaxNumber": "877-407-4329",
"EnumerationDate": "08/06/2020",
"LastUpdateDate": "03/18/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT36035",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "5501303813",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}