{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"LastName": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1802 S. UNION AVE",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "TACOMA",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98405-1950",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "253-759-1310",
"MailingAddressFaxNumber": "253-759-1330",
"FirstLinePracticeLocationAddress": "1802 S. UNION AVE",
"SecondLinePracticeLocationAddress": "SUITE 100",
"PracticeLocationAddressCityName": "TACOMA",
"PracticeLocationAddressStateName": "WA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "253-759-1310",
"PracticeLocationAddressFaxNumber": "253-759-1330",
"EnumerationDate": "02/17/2017",
"LastUpdateDate": "04/26/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RAY",
"AuthorizedOfficialFirstName": "SARAH",
"AuthorizedOfficialMiddleName": "KATHLEEN",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "P.T.",
"AuthorizedOfficialTelephoneNumber": "253-759-1310",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "6719",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}