{
"Npi": {
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GRAPE STREET MASSAGE LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "782 COLUMBINE WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CENTRAL POINT",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97502-4802",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "541-261-8625",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "312 S GRAPE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MEDFORD",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97501-3147",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "541-261-8628",
"PracticeLocationAddressFaxNumber": "938-888-7262",
"EnumerationDate": "03/08/2021",
"LastUpdateDate": "03/08/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHORKEY",
"AuthorizedOfficialFirstName": "SAMANTHA",
"AuthorizedOfficialMiddleName": "K",
"AuthorizedOfficialTitle": "OWNER, LICENSED MASSAGE THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "541-261-8628",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}