{
"Npi": {
"NPI": "1114968906",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HEBERT",
"FirstName": "KIMBERLY",
"MiddleName": "MICHELLE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.P.T.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LACKEY",
"OtherFirstName": "KIMBERLY",
"OtherMiddleName": "MICHELLE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "M.P.T.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "3200 LOS ANGELES AVE.",
"SecondLineMailingAddress": "#20",
"MailingAddressCityName": "SIMI VALLEY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93065",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "805-581-4266",
"MailingAddressFaxNumber": "805-581-5049",
"FirstLinePracticeLocationAddress": "3200 LOS ANGELES AVE.",
"SecondLinePracticeLocationAddress": "#20",
"PracticeLocationAddressCityName": "SIMI VALLEY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93065",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "805-581-4266",
"PracticeLocationAddressFaxNumber": "805-581-5049",
"EnumerationDate": "06/10/2006",
"LastUpdateDate": "07/30/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "30034",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}