{
"Npi": {
"NPI": "1487605572",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BROOME ORTHOPEDIC & SPORT PHYSICAL THERAPY",
"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": "800 VALLEY PLZ",
"SecondLineMailingAddress": "SUITE 9",
"MailingAddressCityName": "JOHNSON CITY",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13790-1046",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "607-729-2200",
"MailingAddressFaxNumber": "607-729-2202",
"FirstLinePracticeLocationAddress": "800 VALLEY PLZ",
"SecondLinePracticeLocationAddress": "SUITE 9",
"PracticeLocationAddressCityName": "JOHNSON CITY",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "13790-1046",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "607-729-2200",
"PracticeLocationAddressFaxNumber": "607-729-2202",
"EnumerationDate": "05/13/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PEAKE",
"AuthorizedOfficialFirstName": "GREGORY",
"AuthorizedOfficialMiddleName": "TODD",
"AuthorizedOfficialTitle": "OWNER/PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "607-729-2200",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "017381-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}