{
"Npi": {
"NPI": "1073062022",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SERENITY THERAPEUTIC MASSAGE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "912 W MAIN ST STE 201",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW HOLLAND",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17557-9202",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "717-466-9102",
"MailingAddressFaxNumber": "717-556-8818",
"FirstLinePracticeLocationAddress": "912 W MAIN ST STE 201",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEW HOLLAND",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "17557-9202",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "717-466-9102",
"PracticeLocationAddressFaxNumber": "717-556-8818",
"EnumerationDate": "09/30/2016",
"LastUpdateDate": "09/30/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WEAVER",
"AuthorizedOfficialFirstName": "IOANA",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "LICENSED MASSAGE THERAPIST/ OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMT",
"AuthorizedOfficialTelephoneNumber": "717-466-9102",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "MSG004082",
"LicenseNumberStateCode": "PA",
"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."
}
}
}
}