{
"Npi": {
"NPI": "1396987046",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MIND-BODY MANAGEMENT, LTD.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "108 S CHURCH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MACUNGIE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "18062-1038",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "610-462-5585",
"MailingAddressFaxNumber": "610-966-5616",
"FirstLinePracticeLocationAddress": "108 S CHURCH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MACUNGIE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "18062-1038",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "610-462-5585",
"PracticeLocationAddressFaxNumber": "610-966-5616",
"EnumerationDate": "03/26/2009",
"LastUpdateDate": "06/15/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEIACO",
"AuthorizedOfficialFirstName": "KELLI",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHD",
"AuthorizedOfficialTelephoneNumber": "610-462-5585",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "PC004790",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}