{"npi":"1275258485","type":"NPI-2","status":"active","name":{"display":"Emerald Bay Physical Therapy PC","other":[],"organization_name":"EMERALD BAY PHYSICAL THERAPY PC","authorised_official":"Stacey Mullins"},"specialty":{"primary_taxonomy":"208100000X","primary_taxonomy_description":"Physical Medicine & Rehabilitation","slug":"physical-medicine-rehabilitation","schema_org_specialty":"Musculoskeletal","all":[{"code":"208100000X","description":"Physical Medicine & Rehabilitation","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"812 EMERALD BAY RD","city":"SOUTH LAKE TAHOE","state":"CA","postal_code":"961506413","country_code":"US","phone":"5305422662","fax":"5305422661"},{"purpose":"MAILING","street_1":"812 EMERALD BAY RD","city":"SOUTH LAKE TAHOE","state":"CA","postal_code":"961506413","country_code":"US","phone":"5305422662","fax":"5305422661"}],"license":null,"identifiers":[{"type_code":"01","label":"Other","value":"12524419","state":null,"issuer":"CAQH"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20221209000056","type_code":"12-65","type_desc":"PART B SUPPLIER - PHYSICAL/OCCUPATIONAL THERAPY GROUP IN PRIVATE PRACTICE","state":"CA","pac_id":"2264801513"}]},"enumeration_date":"2022-10-10","last_updated":"2023-12-28","_meta":{"source":"NPPES","snapshot_date":"2023-12-28","doc_url":"https://findmynpi.com/api"}}