{
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"FirstLineMailingAddress": "15300 JOG ROAD",
"SecondLineMailingAddress": "SUITE 107-108",
"MailingAddressCityName": "DELRAY BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33446-2164",
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"MailingAddressFaxNumber": "561-495-3886",
"FirstLinePracticeLocationAddress": "8198 JOG RD.",
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"PracticeLocationAddressCityName": "BOYNTON BEACH",
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"PracticeLocationAddressTelephoneNumber": "561-742-5959",
"PracticeLocationAddressFaxNumber": "561-495-3886",
"EnumerationDate": "05/23/2006",
"LastUpdateDate": "02/24/2009",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT19697",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}