{
"Npi": {
"NPI": "1477572980",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BUFFALO BACK & NECK PHYSICAL THERAPY, P.C.",
"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": "1060 NIAGARA FALLS BLVD",
"SecondLineMailingAddress": "SUITE 5",
"MailingAddressCityName": "TONAWANDA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14150",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "716-836-2225",
"MailingAddressFaxNumber": "716-836-2712",
"FirstLinePracticeLocationAddress": "1060 NIAGARA FALLS BLVD",
"SecondLinePracticeLocationAddress": "SUITE 5",
"PracticeLocationAddressCityName": "TONAWANDA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14150",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "716-836-2225",
"PracticeLocationAddressFaxNumber": "716-836-2712",
"EnumerationDate": "07/18/2006",
"LastUpdateDate": "03/18/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SMITH",
"AuthorizedOfficialFirstName": "MATTHEW",
"AuthorizedOfficialMiddleName": "CHRISTOPHER",
"AuthorizedOfficialTitle": "PRESIDENT -SECRETARY",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT, DPT,",
"AuthorizedOfficialTelephoneNumber": "716-836-2225",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2251X0800X",
"TaxonomyName": "Orthopedic Physical Therapist",
"LicenseNumber": "018465-1",
"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."
}
}
}
}