{
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"OrgName": "IMPETUS PHYSICAL THERAPY PLLC",
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"FirstLineMailingAddress": "501 5TH AVE",
"SecondLineMailingAddress": "ROOM 2200",
"MailingAddressCityName": "NEW YORK",
"MailingAddressStateName": "NY",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "501 5TH AVENUE",
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"PracticeLocationAddressCityName": "NEW YORK",
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"EnumerationDate": "12/05/2014",
"LastUpdateDate": "12/05/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FRANK",
"AuthorizedOfficialFirstName": "ELISABETH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHYSICAL THERPAY",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DPT",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "027944",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}