{
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"FirstLineMailingAddress": "47 N MAIN ST",
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"EnumerationDate": "10/20/2006",
"LastUpdateDate": "12/26/2025",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "BALAVENDER",
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"AuthorizedOfficialCredential": "MS,PT",
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"Taxonomy": [
{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}