{
"Npi": {
"NPI": "1134636269",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ELEVATION PHYSICAL THERAPY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "985 W RIVERDALE RD STE 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIVERDALE",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84405-5601",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "385-405-2712",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "985 W RIVERDALE RD STE 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIVERDALE",
"PracticeLocationAddressStateName": "UT",
"PracticeLocationAddressPostalCode": "84405-5601",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "385-405-2712",
"PracticeLocationAddressFaxNumber": "888-595-6786",
"EnumerationDate": "01/10/2018",
"LastUpdateDate": "01/10/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EREKSON",
"AuthorizedOfficialFirstName": "JACOB",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "PT DIRECTOR/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "385-405-2712",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2251X0800X",
"TaxonomyName": "Orthopedic Physical Therapist",
"LicenseNumber": "7376354-2401",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}