{
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"FirstLineMailingAddress": "300 PELHAM DR",
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"MailingAddressCityName": "WAYNESBORO",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22980-1511",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "100 BALDWIN BLVD",
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"PracticeLocationAddressCityName": "FISHERSVILLE",
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"PracticeLocationAddressTelephoneNumber": "540-887-4073",
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"EnumerationDate": "04/13/2018",
"LastUpdateDate": "04/13/2018",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": "2305209352",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}