{
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"IsOrgSubpart": "N",
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"LastName": null,
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"FirstLineMailingAddress": "530 E 1ST AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOUNT DORA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32757-5609",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-383-0004",
"MailingAddressFaxNumber": "352-383-0004",
"FirstLinePracticeLocationAddress": "245 S HIGHLAND ST",
"SecondLinePracticeLocationAddress": "SUITE 6",
"PracticeLocationAddressCityName": "MOUNT DORA",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressTelephoneNumber": "352-383-0004",
"PracticeLocationAddressFaxNumber": "352-383-0004",
"EnumerationDate": "07/07/2010",
"LastUpdateDate": "07/07/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHAH",
"AuthorizedOfficialFirstName": "SHAMAYA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMT",
"AuthorizedOfficialTelephoneNumber": "352-383-0004",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "MA4338",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}