{
"Npi": {
"NPI": "1275716128",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BLANCO",
"FirstName": "YVONNE",
"MiddleName": "CECILIA",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "PT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SAYAGO",
"OtherFirstName": "YVONNE",
"OtherMiddleName": "CECILIA",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "PT",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "7780 MARSH CT NW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30328-1800",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-252-2274",
"MailingAddressFaxNumber": "404-252-2274",
"FirstLinePracticeLocationAddress": "1165 PEPSI PL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHARLOTTESVILLE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22901-2866",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "434-951-4200",
"PracticeLocationAddressFaxNumber": "434-951-4202",
"EnumerationDate": "12/14/2007",
"LastUpdateDate": "12/14/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT007929",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "2305003624",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}