{
"Npi": {
"NPI": "1831260504",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THREE VILLAGE PHYSICAL THERAPY PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6 OUTPOST LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HILTON HEAD ISLAND",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29928-3802",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-355-2120",
"MailingAddressFaxNumber": "843-686-4000",
"FirstLinePracticeLocationAddress": "97 MAIN ST",
"SecondLinePracticeLocationAddress": "SUITE F",
"PracticeLocationAddressCityName": "STONY BROOK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11790-1937",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-355-2120",
"PracticeLocationAddressFaxNumber": "843-686-4000",
"EnumerationDate": "11/13/2006",
"LastUpdateDate": "11/10/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAYTON",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT,CFMT",
"AuthorizedOfficialTelephoneNumber": "631-355-2120",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "014253-1",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}