{
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"IsOrgSubpart": "N",
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"OrgName": "CONVERGENT MOVEMENT AND PERFORMANCE LLC",
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"NamePrefix": null,
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"FirstLineMailingAddress": "726 ROUTE 202",
"SecondLineMailingAddress": "SUITE 320 UNIT 200",
"MailingAddressCityName": "BRIDGEWATER",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08807-2737",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1200 US HIGHWAY 22 EAST",
"SecondLinePracticeLocationAddress": "SUITE 2000 UNIT W7",
"PracticeLocationAddressCityName": "BRIDGEWATER",
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"PracticeLocationAddressPostalCode": "08807-2943",
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"PracticeLocationAddressTelephoneNumber": "908-304-3620",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/01/2017",
"LastUpdateDate": "10/03/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KETSELMAN",
"AuthorizedOfficialFirstName": "EUGENE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.P.T.",
"AuthorizedOfficialTelephoneNumber": "908-304-3620",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "40QA01566100",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}