{
"Npi": {
"NPI": "1760148514",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ARSENAL ORTHOPAEDIC AND SPORT PHYSICAL THERAPY, INC",
"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": "13195 KNOTTY PINE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOORPARK",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93021-2161",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "805-402-2949",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1090 LAWRENCE DR STE 101",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "THOUSAND OAKS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91320-1315",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "805-402-2949",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/16/2021",
"LastUpdateDate": "11/16/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BROUHARD",
"AuthorizedOfficialFirstName": "JUSTIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT, TREASURER, SECRETARY",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "805-402-2949",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2251X0800X",
"TaxonomyName": "Orthopedic Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}