{
"Npi": {
"NPI": "1538497037",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BERGIN",
"FirstName": "DANA",
"MiddleName": "ANN",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "DPT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CAUDA",
"OtherFirstName": "DANA",
"OtherMiddleName": "ANN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "DPT",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PROGRESSIVE PHYSICAL THERAPY, PC",
"SecondLineMailingAddress": "700 BROADWAY",
"MailingAddressCityName": "MASSAPEQUA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11758-6621",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-797-7003",
"MailingAddressFaxNumber": "516-797-7336",
"FirstLinePracticeLocationAddress": "PROGRESSIVE PHYSICAL THERAPY, PC",
"SecondLinePracticeLocationAddress": "700 BROADWAY",
"PracticeLocationAddressCityName": "MASSAPEQUA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11758-6621",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-797-7003",
"PracticeLocationAddressFaxNumber": "516-797-7336",
"EnumerationDate": "11/23/2009",
"LastUpdateDate": "04/22/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "40QA01337600",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "034390",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}