{
"Npi": {
"NPI": "1861948739",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RENEU PHYSICAL THERAPY LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2608 CLOVER FIELD CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHASKA",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55318-3233",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-860-6525",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "101 LAKE ST W STE 210",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WAYZATA",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55391-1578",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "612-562-6581",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/30/2016",
"LastUpdateDate": "06/04/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MILLER",
"AuthorizedOfficialFirstName": "NATALIE",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "OWNER, PT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT, DPT, OCS",
"AuthorizedOfficialTelephoneNumber": "612-860-6525",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "8820",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}