{
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"FirstLineMailingAddress": "1012 S CENTRAL AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FLAGLER BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32136-3723",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "386-447-0670",
"FirstLinePracticeLocationAddress": "397 PALM COAST PARKWAY SW",
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"PracticeLocationAddressCityName": "PALM COAST",
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"PracticeLocationAddressTelephoneNumber": "386-447-0610",
"PracticeLocationAddressFaxNumber": "386-447-0670",
"EnumerationDate": "06/07/2006",
"LastUpdateDate": "07/08/2007",
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"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Orthopedic Physical Therapist",
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"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}