{
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"FirstLineMailingAddress": "902 KITTY HAWK RD",
"SecondLineMailingAddress": "SUITE170 BOX 469",
"MailingAddressCityName": "UNIVERSAL CITY",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "4241 WOODCOCK DR STE C115",
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"PracticeLocationAddressCityName": "SAN ANTONIO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "210-712-6475",
"PracticeLocationAddressFaxNumber": "210-829-1828",
"EnumerationDate": "03/17/2008",
"LastUpdateDate": "08/06/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Massage Therapist",
"LicenseNumber": "MT026903",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}