{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "INTEGRATIVE PHYSICAL THERAPY, LLC",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "37 SOUNDVIEW RD",
"SecondLineMailingAddress": "SUITE 2",
"MailingAddressCityName": "GUILFORD",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06437-2916",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-453-4321",
"MailingAddressFaxNumber": "203-453-4322",
"FirstLinePracticeLocationAddress": "37 SOUNDVIEW RD",
"SecondLinePracticeLocationAddress": "SUITE 2",
"PracticeLocationAddressCityName": "GUILFORD",
"PracticeLocationAddressStateName": "CT",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-453-4321",
"PracticeLocationAddressFaxNumber": "203-453-4322",
"EnumerationDate": "02/26/2007",
"LastUpdateDate": "11/10/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SEGNERE",
"AuthorizedOfficialFirstName": "DONNA",
"AuthorizedOfficialMiddleName": "LYNN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "203-453-4321",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "005209",
"LicenseNumberStateCode": "CT",
"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."
}
}
}
}