{
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"FirstLineMailingAddress": "2219 COUNTY ROAD 220 STE 304",
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"MailingAddressTelephoneNumber": "904-644-7722",
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"FirstLinePracticeLocationAddress": "1305 N ORANGE AVE STE 118",
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"PracticeLocationAddressCityName": "GREEN COVE SPRINGS",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": "904-637-1532",
"EnumerationDate": "08/02/2023",
"LastUpdateDate": "08/02/2023",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VOLLERTSEN",
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"AuthorizedOfficialTelephoneNumber": "904-644-7722",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapy Clinic/Center",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}