{
"Npi": {
"NPI": "1003794462",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ABBATANGELO",
"FirstName": "NICHOLAS",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DPT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4 RICHMOND SQ STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PROVIDENCE",
"MailingAddressStateName": "RI",
"MailingAddressPostalCode": "02906-5117",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "401-433-4172",
"MailingAddressFaxNumber": "401-433-0612",
"FirstLinePracticeLocationAddress": "115 NORWOOD PARK S STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORWOOD",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "02062-4633",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "781-702-4630",
"PracticeLocationAddressFaxNumber": "781-702-4510",
"EnumerationDate": "08/25/2025",
"LastUpdateDate": "08/25/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PTL88553",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}