{
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"EIN": null,
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"OtherCredential": "PHYSICAL THERAPIST",
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"FirstLineMailingAddress": "177 NORTHBAY CT",
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"MailingAddressCityName": "GLEN CARBON",
"MailingAddressStateName": "IL",
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"FirstLinePracticeLocationAddress": "11210 SCHUETZ RD",
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"PracticeLocationAddressCityName": "SAINT LOUIS",
"PracticeLocationAddressStateName": "MO",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/01/2017",
"LastUpdateDate": "09/01/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": "R1379",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}