{
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"FirstLineMailingAddress": "PO BOX 272195",
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"MailingAddressCityName": "FORT COLLINS",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80527-2195",
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"FirstLinePracticeLocationAddress": "215 N REHOBOTH BLVD",
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"PracticeLocationAddressCityName": "MILFORD",
"PracticeLocationAddressStateName": "DE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "302-236-0063",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/31/2017",
"LastUpdateDate": "05/31/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Massage Therapist",
"LicenseNumber": "MT0003944",
"LicenseNumberStateCode": "DE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}