{
"Npi": {
"NPI": "1851774475",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FELICE PHYSICAL THERAPY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3190 LAWNDALE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FINKSBURG",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21048-1565",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "315-408-8341",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "11270 PEPPER RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HUNT VALLEY",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21031-1202",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "315-408-8341",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/30/2015",
"LastUpdateDate": "01/07/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FELICE",
"AuthorizedOfficialFirstName": "JEROD",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "315-408-8341",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "22634",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}