{
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"NPI": "1598303877",
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"EIN": null,
"IsSoleProprietor": "Y",
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"NameSuffix": null,
"Credential": "CMT, MMP",
"OtherOrgName": null,
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"OtherLastName": "MERKELBACH-FELDMAN",
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"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "PO BOX 291269",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHELAN",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92329-1269",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-706-8839",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "10350 WILSON RANCH RD UNIT A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PHELAN",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92371-7159",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-261-8895",
"PracticeLocationAddressFaxNumber": "760-281-6315",
"EnumerationDate": "12/17/2019",
"LastUpdateDate": "12/17/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
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"AuthorizedOfficialTitle": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "15628",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}