{
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"OtherCredential": "P.T.",
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"FirstLineMailingAddress": "1033 KIRKHILL DR",
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"MailingAddressStateName": "CA",
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"FirstLinePracticeLocationAddress": "1680 E ROSEVILLE PKWY",
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"EnumerationDate": "03/19/2007",
"LastUpdateDate": "06/10/2016",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
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"TaxonomyName": "Physical Therapist",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}