{
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"FirstLineMailingAddress": "9871 BROCKINGTON RD STE 1",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHERWOOD",
"MailingAddressStateName": "AR",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9871 BROCKINGTON ROAD",
"SecondLinePracticeLocationAddress": "SUITE #1",
"PracticeLocationAddressCityName": "SHERWOOD",
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"PracticeLocationAddressCountryCode": "US",
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"EnumerationDate": "08/07/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Massage Therapist",
"LicenseNumber": "3366",
"LicenseNumberStateCode": "AR",
"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."
}
}
}
}