{
"Npi": {
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"EIN": null,
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"Credential": "PT",
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"OtherCredential": "PT",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "11848 STONEBRIDGE DR W",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32223-1886",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-880-1788",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "11701 SAN JOSE BLVD",
"SecondLinePracticeLocationAddress": "SUITE 210",
"PracticeLocationAddressCityName": "JACKSONVILLE",
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"PracticeLocationAddressPostalCode": "32223-0756",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-858-7450",
"PracticeLocationAddressFaxNumber": "904-858-7451",
"EnumerationDate": "02/09/2007",
"LastUpdateDate": "07/08/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT6320",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}