{
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"EIN": null,
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"ParentOrgLBN": null,
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"OrgName": "GODDARD ORTHOPEDIC AND SPORTS THERAPY INC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1199 S BELT LINE RD",
"SecondLineMailingAddress": "SUITE 140",
"MailingAddressCityName": "COPPELL",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75019-4666",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-745-9060",
"MailingAddressFaxNumber": "972-745-9069",
"FirstLinePracticeLocationAddress": "1199 S BELT LINE RD",
"SecondLinePracticeLocationAddress": "SUITE 140",
"PracticeLocationAddressCityName": "COPPELL",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75019-4666",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-745-9060",
"PracticeLocationAddressFaxNumber": "972-745-9069",
"EnumerationDate": "11/09/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GODDARD",
"AuthorizedOfficialFirstName": "AMY",
"AuthorizedOfficialMiddleName": "LOUISE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT CSCS",
"AuthorizedOfficialTelephoneNumber": "972-745-9060",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": "1101657",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}