{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "CORRECTIVE MUSCULAR THERAPY LLC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "1717 W 86TH ST",
"SecondLineMailingAddress": "SUITE 800 SOUTH",
"MailingAddressCityName": "INDIANAPOLIS",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46260-2050",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "317-517-1562",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1717 W 86TH ST",
"SecondLinePracticeLocationAddress": "SUITE 800 SOUTH",
"PracticeLocationAddressCityName": "INDIANAPOLIS",
"PracticeLocationAddressStateName": "IN",
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"PracticeLocationAddressTelephoneNumber": "317-517-1562",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/25/2012",
"LastUpdateDate": "09/25/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TRUEB",
"AuthorizedOfficialFirstName": "SARAH",
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"AuthorizedOfficialCredential": "CMT, LMT, MMP",
"AuthorizedOfficialTelephoneNumber": "317-517-1562",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "MT20902941",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}