{
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"ParentOrgLBN": null,
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"OrgName": "CANYON RANCH PHYSICAL THERAPY, INC.",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "7710 STEWART ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLTON",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92324-9626",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-370-2270",
"MailingAddressFaxNumber": "909-370-2288",
"FirstLinePracticeLocationAddress": "7710 STEWART ST",
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"PracticeLocationAddressCityName": "COLTON",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-370-2270",
"PracticeLocationAddressFaxNumber": "909-370-2288",
"EnumerationDate": "06/11/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KERN",
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"AuthorizedOfficialCredential": "MPT",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "PT25067",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}