{
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"FirstLineMailingAddress": "321 SECTION LINE RD STE E",
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"EnumerationDate": "06/14/2023",
"LastUpdateDate": "07/18/2023",
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"NPIReactivationDate": null,
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"Gender": null,
"AuthorizedOfficialLastName": "RODGERS",
"AuthorizedOfficialFirstName": "JONATHAN",
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"AuthorizedOfficialCredential": "DPT",
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"Taxonomies": {
"Taxonomy": {
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}