{
"Npi": {
"NPI": "1366027310",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BRANCH",
"FirstName": "MARY",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PTA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GILLESPIE",
"OtherFirstName": "MARY",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "440 MERCHANT DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORMAN",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73069-6470",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "405-809-8713",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "815 NW 12TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OKLAHOMA CITY",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "73106-6802",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "405-231-5800",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/11/2021",
"LastUpdateDate": "02/22/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225200000X",
"TaxonomyName": "Physical Therapy Assistant",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}