{
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"FirstLineMailingAddress": "722 SHEPARD LN STE 105",
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"MailingAddressStateName": "UT",
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"MailingAddressFaxNumber": "801-447-9552",
"FirstLinePracticeLocationAddress": "1700 ADAMS AVE",
"SecondLinePracticeLocationAddress": "SUITE 201",
"PracticeLocationAddressCityName": "COSTA MESA",
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"EnumerationDate": "08/12/2025",
"LastUpdateDate": "08/12/2025",
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"AuthorizedOfficialLastName": "RHODES",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}