{
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"Credential": "LICENSED MASSAGE THE",
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"FirstLineMailingAddress": "10004 GLACIER HWY STE B",
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"MailingAddressCityName": "JUNEAU",
"MailingAddressStateName": "AK",
"MailingAddressPostalCode": "99801",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "907-891-7376",
"FirstLinePracticeLocationAddress": "10004 GLACIER HWY STE B",
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"PracticeLocationAddressCityName": "JUNEAU",
"PracticeLocationAddressStateName": "AK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "907-500-4888",
"PracticeLocationAddressFaxNumber": "907-891-7376",
"EnumerationDate": "07/06/2017",
"LastUpdateDate": "03/01/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "102007",
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}