{
"Npi": {
"NPI": "1154750321",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VITALITY GROUP OF WNY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2338 IMMOKALEE RD",
"SecondLineMailingAddress": "#105",
"MailingAddressCityName": "NAPLES",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34110-1445",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "239-269-3279",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3670 MCKINLEY PKWY",
"SecondLinePracticeLocationAddress": "MASSAGE ENVY",
"PracticeLocationAddressCityName": "BLASDELL",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14219-2696",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "716-822-3689",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/07/2013",
"LastUpdateDate": "11/07/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MORSE",
"AuthorizedOfficialFirstName": "FRED",
"AuthorizedOfficialMiddleName": "GRANT",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "239-269-3279",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "21MA1407640",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}