{
"Npi": {
"NPI": "1548425101",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FONDA",
"FirstName": "BARBARA",
"MiddleName": "JO",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "MASSAGE THERAPIST",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "FONDA",
"OtherFirstName": "BARBARA",
"OtherMiddleName": "JO",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "MASSAGE THERAPIST",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "PO BOX 701",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OGDENSBURG",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13669-0701",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "315-713-4170",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "609 CANTON ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OGDENSBURG",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "13669-3811",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "315-393-1018",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/23/2008",
"LastUpdateDate": "07/23/2008",
"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": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "019099",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}