{
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"NamePrefix": null,
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"FirstLineMailingAddress": "1512 NE 96TH ST",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "LIBERTY",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "64068-1348",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "816-792-0775",
"MailingAddressFaxNumber": "816-792-0776",
"FirstLinePracticeLocationAddress": "1512 NE 96TH ST",
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"PracticeLocationAddressTelephoneNumber": "816-792-0775",
"PracticeLocationAddressFaxNumber": "816-792-0776",
"EnumerationDate": "05/08/2006",
"LastUpdateDate": "11/02/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HELMER",
"AuthorizedOfficialFirstName": "CHAD",
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"AuthorizedOfficialCredential": "PT",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": "112594",
"LicenseNumberStateCode": "MO",
"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."
}
}
}
}