{
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"FirstLineMailingAddress": "3992 133RD CT W",
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"MailingAddressStateName": "MN",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "612-429-4568",
"FirstLinePracticeLocationAddress": "7420 4TH AVE S",
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"PracticeLocationAddressCityName": "RICHFIELD",
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"EnumerationDate": "01/24/2021",
"LastUpdateDate": "10/31/2022",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "WALL",
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"TaxonomyName": "Physical Therapy Clinic/Center",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}