{
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"IsOrgSubpart": "N",
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"OrgName": "MIND AND BODY MASSAGE, HEALTH AND WELLNESS LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "5330 RAEFORD RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FAYETTEVILLE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28304-3074",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "910-307-7320",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5330 RAEFORD RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FAYETTEVILLE",
"PracticeLocationAddressStateName": "NC",
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"PracticeLocationAddressTelephoneNumber": "910-307-7320",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/01/2017",
"LastUpdateDate": "06/01/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STURDIVANT",
"AuthorizedOfficialFirstName": "ARNETTA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "LICENSED MASSAGE THERPIST/ OWNER",
"AuthorizedOfficialNamePrefix": "MISS",
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"AuthorizedOfficialCredential": "LMBT,",
"AuthorizedOfficialTelephoneNumber": "910-307-7320",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "12235",
"LicenseNumberStateCode": "NC",
"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."
}
}
}
}