{
"Npi": {
"NPI": "1437668050",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MULDER",
"FirstName": "KRISTIE",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DPT, CSCS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KOPPINGER",
"OtherFirstName": "KRISTIE",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "DPT, CSCS",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1210 S LAPEER RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKE ORION",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48360-1433",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-814-8060",
"MailingAddressFaxNumber": "248-814-8070",
"FirstLinePracticeLocationAddress": "317 E WACKERLY ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MIDLAND",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48642-7062",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "989-832-9300",
"PracticeLocationAddressFaxNumber": "989-832-9301",
"EnumerationDate": "09/26/2017",
"LastUpdateDate": "04/05/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "5501018238",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}