{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "MOVEMENT SPORTS PHYSICAL THERAPY, LLC",
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"FirstLineMailingAddress": "3280 PEACHTREE RD NE STE 160",
"SecondLineMailingAddress": "AT FUSION ATL",
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30305-2430",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-382-8667",
"MailingAddressFaxNumber": "678-823-8214",
"FirstLinePracticeLocationAddress": "3280 PEACHTREE RD NE STE 160",
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"PracticeLocationAddressCityName": "ATLANTA",
"PracticeLocationAddressStateName": "GA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-382-8667",
"PracticeLocationAddressFaxNumber": "678-823-8214",
"EnumerationDate": "01/29/2013",
"LastUpdateDate": "08/27/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YEE",
"AuthorizedOfficialFirstName": "BRIAN",
"AuthorizedOfficialMiddleName": "ARTHUR",
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "404-441-0206",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT008407",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}