{
"Npi": {
"NPI": "1790013654",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MUSCLE EZE LLC",
"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": "2620 MANATEE AVE W",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "BRADENTON",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34205-4944",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "941-981-0880",
"MailingAddressFaxNumber": "941-932-8094",
"FirstLinePracticeLocationAddress": "2620 MANATEE AVE W",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "BRADENTON",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34205-4944",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "941-981-0880",
"PracticeLocationAddressFaxNumber": "941-932-8094",
"EnumerationDate": "12/03/2009",
"LastUpdateDate": "07/21/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOLMES",
"AuthorizedOfficialFirstName": "NEIL",
"AuthorizedOfficialMiddleName": "W",
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMT",
"AuthorizedOfficialTelephoneNumber": "941-981-0880",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "MM24923",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}