{
"Npi": {
"NPI": "1598371783",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GARZA-WILT",
"FirstName": "LAURA",
"MiddleName": "J",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LMT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GARZA",
"OtherFirstName": "LAURA",
"OtherMiddleName": "J",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "LMT",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "5814 KATELYN MARY PL UNIT 304",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALEXANDRIA",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22310-5445",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-405-5095",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5814 KATELYN MARY PL UNIT 304",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALEXANDRIA",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22310-5445",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-405-5095",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/22/2020",
"LastUpdateDate": "12/05/2022",
"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": "MT2248",
"LicenseNumberStateCode": "DC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "0019010887",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "MA100735",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}