{
"Npi": {
"NPI": "1205249323",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BODY WELLNESS PHYSICAL THERAPY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "12653 93RD PL NE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KIRKLAND",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98034-5911",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-305-0576",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2340 130TH AVE NE",
"SecondLinePracticeLocationAddress": "BLDG D - SUITE 200",
"PracticeLocationAddressCityName": "BELLEVUE",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98005-1700",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "425-305-0576",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/05/2014",
"LastUpdateDate": "12/01/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VAKHNENKO",
"AuthorizedOfficialFirstName": "LYUDMILA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT, DPT",
"AuthorizedOfficialTelephoneNumber": "425-305-0576",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT 60219395",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}