{
"Npi": {
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "CONNECTICUT SPORTS CLINIC LLC",
"LastName": null,
"FirstName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "57 ORANGE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW HAVEN",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06510-3150",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-589-0226",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "129 CHURCH ST FL 1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEW HAVEN",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06510-2026",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-200-0099",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/13/2018",
"LastUpdateDate": "03/21/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOM",
"AuthorizedOfficialFirstName": "GREGORY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "203-589-0226",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "2028",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}