{
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"EIN": null,
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"OrgName": "BCM INNOVATIVE THERAPIES",
"LastName": null,
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"FirstLineMailingAddress": "3728 S HWY 287",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORSICANA",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75109-8960",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3728 S HWY 287",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CORSICANA",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "903-874-6315",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/13/2014",
"LastUpdateDate": "10/13/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOYER",
"AuthorizedOfficialFirstName": "SAMANTHA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST",
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"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "610-737-2524",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": "1249341",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}