{
"Npi": {
"NPI": "1083622161",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TLC MASSAGE, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2774 POINTE CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GREENACRES",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33413-2153",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-439-3262",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2072 S MILITARY TRL",
"SecondLinePracticeLocationAddress": "SUITE 7",
"PracticeLocationAddressCityName": "WEST PALM BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33415-6419",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-965-5500",
"PracticeLocationAddressFaxNumber": "561-965-5592",
"EnumerationDate": "08/04/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RENDON",
"AuthorizedOfficialFirstName": "NELLIE",
"AuthorizedOfficialMiddleName": "ESTHER",
"AuthorizedOfficialTitle": "LICENSE MASSAGE THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMT",
"AuthorizedOfficialTelephoneNumber": "561-965-5500",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "MA0012117",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}