{
"Npi": {
"NPI": "1821637653",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TYLER J KENTON DPT PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "129 N 3RD ST APT 309",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROOKLYN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11249-3980",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "302-233-1210",
"MailingAddressFaxNumber": "332-777-1315",
"FirstLinePracticeLocationAddress": "666 BROADWAY LOWR LEVEL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10012-2317",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "302-233-1210",
"PracticeLocationAddressFaxNumber": "332-777-1315",
"EnumerationDate": "12/26/2019",
"LastUpdateDate": "10/07/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KENTON",
"AuthorizedOfficialFirstName": "TYLER",
"AuthorizedOfficialMiddleName": "JOSEPH",
"AuthorizedOfficialTitle": "MEMBER/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "302-233-1210",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2251X0800X",
"TaxonomyName": "Orthopedic Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}