{
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"OrgName": "REAGAN REHABILITATION OUTPATIENT THERAPY, LLC",
"LastName": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1736",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LEBANON",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "65536-1736",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "417-718-0712",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "200 W COMMERCIAL ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LEBANON",
"PracticeLocationAddressStateName": "MO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "417-718-0712",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/28/2014",
"LastUpdateDate": "07/07/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REAGAN",
"AuthorizedOfficialFirstName": "JONATHAN",
"AuthorizedOfficialMiddleName": "DW",
"AuthorizedOfficialTitle": "OWNER/STAFF THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MPT",
"AuthorizedOfficialTelephoneNumber": "855-786-8782",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "2001015007",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}