{
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"ParentOrgLBN": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "331 DEERFIELD LAKE CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LONGVIEW",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75605-7756",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "903-241-1274",
"MailingAddressFaxNumber": "903-297-6453",
"FirstLinePracticeLocationAddress": "2628 BILL OWENS PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LONGVIEW",
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"PracticeLocationAddressPostalCode": "75604-3001",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "903-241-1274",
"PracticeLocationAddressFaxNumber": "903-297-6453",
"EnumerationDate": "06/21/2020",
"LastUpdateDate": "06/21/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RUDOLPH",
"AuthorizedOfficialFirstName": "SARAH",
"AuthorizedOfficialMiddleName": "YVONNE",
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"AuthorizedOfficialCredential": "P.T.",
"AuthorizedOfficialTelephoneNumber": "903-241-1274",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}