{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "PHYSIO MOVEMENT & PERFORMANCE, PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "7719 64TH AVE E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PUYALLUP",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98371-5515",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "253-200-0741",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "615 S BAKER ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TACOMA",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98402-2318",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "253-200-0741",
"PracticeLocationAddressFaxNumber": "253-300-1665",
"EnumerationDate": "03/02/2020",
"LastUpdateDate": "06/30/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RUCKER",
"AuthorizedOfficialFirstName": "REBECCA",
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"AuthorizedOfficialTitle": "OWNER/PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "253-200-0741",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}