{
"Npi": {
"NPI": "1548565476",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JETMORE-REICHARDT",
"FirstName": "MARY",
"MiddleName": "VICTORIA",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "MP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 6493",
"SecondLineMailingAddress": "22652 WATERS DRIVE",
"MailingAddressCityName": "CRESTLINE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92325-6493",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "916-201-3908",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "580 FOREST SHADE #4",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CRESTLINE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92325",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-338-6477",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/25/2011",
"LastUpdateDate": "01/25/2011",
"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": "10826",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}