{
"Npi": {
"NPI": "1205047438",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SHAW",
"FirstName": "SARAH",
"MiddleName": "ANN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MPT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "TYNDALL",
"OtherFirstName": "SARAH",
"OtherMiddleName": "ANN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MPT",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "2627 S WARNOCK ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHILADELPHIA",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19148-4418",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2817 REILLY ROAD",
"SecondLinePracticeLocationAddress": "DEPARTMENT OF ORTHO & REHAB",
"PracticeLocationAddressCityName": "FORT BRAGG",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28310-3500",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "910-907-9798",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/28/2007",
"LastUpdateDate": "06/29/2020",
"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": "2251X0800X",
"TaxonomyName": "Orthopedic Physical Therapist",
"LicenseNumber": "PT018355",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2251X0800X",
"TaxonomyName": "Orthopedic Physical Therapist",
"LicenseNumber": "P17581",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}