{
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"FirstLineMailingAddress": "2999 KENDALL DR",
"SecondLineMailingAddress": "STE 204 PMB 1014",
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"FirstLinePracticeLocationAddress": "3610 CENTRAL AVE STE 400",
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"PracticeLocationAddressCityName": "RIVERSIDE",
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"EnumerationDate": "10/04/2023",
"LastUpdateDate": "04/03/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCOTT",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}