{
"Npi": {
"NPI": "1780924159",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WELLS PHYSICAL THERAPY, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "15569 VALLECAS LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NAPLES",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34110-2829",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-568-1156",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "15569 VALLECAS LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NAPLES",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34110-2829",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-568-1156",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/22/2013",
"LastUpdateDate": "01/30/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WELLS",
"AuthorizedOfficialFirstName": "SEAN",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER AND PT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT, PT, OCS, ATC",
"AuthorizedOfficialTelephoneNumber": "904-568-1156",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225100000X",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}