{
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"EIN": null,
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"FirstLineMailingAddress": "8700 COVE MEADOW LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT WORTH",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76123-2505",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-370-8204",
"MailingAddressFaxNumber": "817-370-8634",
"FirstLinePracticeLocationAddress": "5701 WESTCREEK DR",
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"PracticeLocationAddressCityName": "FORT WORTH",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76133-3301",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-423-0021",
"PracticeLocationAddressFaxNumber": "817-370-8634",
"EnumerationDate": "05/08/2007",
"LastUpdateDate": "07/08/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Massage Therapist",
"LicenseNumber": "MT037532",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}