{
"Npi": {
"NPI": "1407660608",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ENDURANCE UNLEASHED, 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": "47 STONE BRIDGE XING",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHAPEL HILL",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27517-7016",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-387-4669",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "47 STONE BRIDGE XING",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHAPEL HILL",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27517-7016",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-387-4669",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/06/2025",
"LastUpdateDate": "03/03/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BERGHORN",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "WILLIAM",
"AuthorizedOfficialTitle": "OWNER/PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "DPT, ATC, USAW",
"AuthorizedOfficialTelephoneNumber": "516-387-4669",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QP3300X",
"TaxonomyName": "Pain Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QR0401X",
"TaxonomyName": "Comprehensive Outpatient Rehabilitation Facility (CORF)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QP0905X",
"TaxonomyName": "State or Local Public Health Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}