{
"Npi": {
"NPI": "1194190421",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FAMA",
"FirstName": "RACHEL",
"MiddleName": "MELISSA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PTA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HOUSE",
"OtherFirstName": "RACHEL",
"OtherMiddleName": "MELISSA",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PTA",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "11657 CHARTER OAK CT APT 201",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RESTON",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "20190-4531",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "585-944-0228",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1936 OPITZ BLVD STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WOODBRIDGE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22191-3360",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "540-841-4443",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/11/2015",
"LastUpdateDate": "02/11/2019",
"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": "225200000X",
"TaxonomyName": "Physical Therapy Assistant",
"LicenseNumber": "2306605075",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}