{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "BLANACED BODY THERAPEUTIC MASSAGE",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "1820 MELROSE DR",
"SecondLineMailingAddress": "#331",
"MailingAddressCityName": "SAN MARCOS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92078-2116",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-216-4270",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1991 VILLAGE PARK WAY",
"SecondLinePracticeLocationAddress": "SUITE 206-A",
"PracticeLocationAddressCityName": "ENCINITAS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92024-1994",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-216-4270",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/07/2011",
"LastUpdateDate": "04/07/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COUDOUX",
"AuthorizedOfficialFirstName": "PHILIPPE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT/MASSAGE THERAPIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "HHP, CMT",
"AuthorizedOfficialTelephoneNumber": "760-216-4270",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "10215",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}