{
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"NPI": "1588154512",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "A QUEENS TOUCH THERAPEUTIC MASSAGE SERVICES",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "158 LANTERN LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RAEFORD",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28376-3254",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "910-308-0892",
"MailingAddressFaxNumber": "657-202-8376",
"FirstLinePracticeLocationAddress": "158 LANTERN LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RAEFORD",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28376-3254",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "910-308-0892",
"PracticeLocationAddressFaxNumber": "657-202-8376",
"EnumerationDate": "05/15/2018",
"LastUpdateDate": "06/16/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOLDING",
"AuthorizedOfficialFirstName": "YOLANDA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MASSAGE THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "910-308-0892",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "16400",
"LicenseNumberStateCode": "NC",
"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."
}
}
}
}