{
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"FirstLineMailingAddress": "2790 W TENNESSEE ST",
"SecondLineMailingAddress": "SUITE 2",
"MailingAddressCityName": "TALLAHASSEE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32304-2840",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-222-9355",
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"FirstLinePracticeLocationAddress": "2790 W TENNESSEE ST",
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"EnumerationDate": "02/28/2008",
"LastUpdateDate": "02/28/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LIPFORD",
"AuthorizedOfficialFirstName": "STEPHANI",
"AuthorizedOfficialMiddleName": "DAWN",
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"AuthorizedOfficialTelephoneNumber": "850-222-9355",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Massage Therapist",
"LicenseNumber": "MM20647",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}