{
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"FirstLineMailingAddress": "10353 BONANZA TRL",
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"MailingAddressCityName": "KEITHVILLE",
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"FirstLinePracticeLocationAddress": "4330 PANTHER DR STE 214",
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"PracticeLocationAddressCityName": "BOSSIER CITY",
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"EnumerationDate": "01/06/2026",
"LastUpdateDate": "01/06/2026",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Massage Therapist",
"LicenseNumber": "LA4110",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}