{
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"EIN": null,
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"FirstLineMailingAddress": "551 N KARLE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WESTLAND",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48185-7412",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "734-331-0885",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "551 N KARLE ST",
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"PracticeLocationAddressCityName": "WESTLAND",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "734-331-0885",
"PracticeLocationAddressFaxNumber": "734-331-0885",
"EnumerationDate": "10/19/2017",
"LastUpdateDate": "10/19/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Massage Therapist",
"LicenseNumber": "7501001009",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}