{
"Npi": {
"NPI": "1598435323",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "REECE",
"FirstName": "PHILLIP",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PROFSSIONAL",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GHANIM",
"OtherFirstName": "MEREL",
"OtherMiddleName": null,
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "ALLAN DO",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "9001 15 MILE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STERLING HEIGHTS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48312-3621",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "586-983-8133",
"MailingAddressFaxNumber": "586-983-8135",
"FirstLinePracticeLocationAddress": "9001 15 MILE RD STE C",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STERLING HEIGHTS",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48312-3621",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "586-604-1704",
"PracticeLocationAddressFaxNumber": "586-983-8135",
"EnumerationDate": "09/14/2021",
"LastUpdateDate": "09/14/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "7501006805",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}