{
"Npi": {
"NPI": "1104779255",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LEGACY PHYSICAL THERAPY AND PERFORMANCE, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8007 DOVEGATE CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MENTOR",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44060-5997",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "813-230-9328",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9061 SR-14",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STREETSBORO",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44241",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "216-452-8606",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/18/2026",
"LastUpdateDate": "02/18/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COLVIN",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER, PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT, DPT, ATC",
"AuthorizedOfficialTelephoneNumber": "813-230-9328",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2251N0400X",
"TaxonomyName": "Neurology Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2251S0007X",
"TaxonomyName": "Sports Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2251X0800X",
"TaxonomyName": "Orthopedic Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}