{
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"FirstLineMailingAddress": "1413 COURTNEY DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KENAI",
"MailingAddressStateName": "AK",
"MailingAddressPostalCode": "99611-6646",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "907-394-8345",
"MailingAddressFaxNumber": "907-283-5350",
"FirstLinePracticeLocationAddress": "43335 KALIFORNSKY BEACH RD STE 25",
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"PracticeLocationAddressCityName": "SOLDOTNA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "907-394-8345",
"PracticeLocationAddressFaxNumber": "907-283-5350",
"EnumerationDate": "11/01/2017",
"LastUpdateDate": "11/01/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NUSBAUM",
"AuthorizedOfficialFirstName": "HANNAH",
"AuthorizedOfficialMiddleName": "CAMILLA",
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMT",
"AuthorizedOfficialTelephoneNumber": "907-394-8645",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "121821",
"LicenseNumberStateCode": "AK",
"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."
}
}
}
}