{
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"FirstLineMailingAddress": "3325 YALE DR",
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"MailingAddressCityName": "EVANSVILLE",
"MailingAddressStateName": "IN",
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"FirstLinePracticeLocationAddress": "1250 MAIN ST",
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"PracticeLocationAddressCityName": "MOUNT VERNON",
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"EnumerationDate": "12/15/2016",
"LastUpdateDate": "12/15/2016",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAHINAY",
"AuthorizedOfficialFirstName": "MICHAEL CONSTANCIO",
"AuthorizedOfficialMiddleName": "RESPICIO",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}