{
"Npi": {
"NPI": "1538792254",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JUAREZ",
"FirstName": "JACQUELYN",
"MiddleName": "EILEEN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PTA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "JUAREZ",
"OtherFirstName": "JACQUELYN",
"OtherMiddleName": "EILEEN",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "JACKIE",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "2500 STATE HIGHWAY 121 APT 323",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EULESS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76039-6008",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "940-366-9486",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2500 STATE HIGHWAY 121 APT 323",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EULESS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76039-6008",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "940-366-9486",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/20/2020",
"LastUpdateDate": "02/20/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225200000X",
"TaxonomyName": "Physical Therapy Assistant",
"LicenseNumber": "2152244",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}