{
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"EIN": null,
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"FirstLineMailingAddress": "430 W EDGEWOOD CT",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "309-260-4209",
"FirstLinePracticeLocationAddress": "430 W EDGEWOOD CT",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "309-263-4200",
"PracticeLocationAddressFaxNumber": "309-260-4209",
"EnumerationDate": "08/12/2006",
"LastUpdateDate": "05/23/2008",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
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"TaxonomyName": "Physical Therapist",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}