{
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"FirstLineMailingAddress": "453 S SHAMOKIN ST",
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"MailingAddressCityName": "SHAMOKIN",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17872-6407",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "453 S SHAMOKIN ST",
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"PracticeLocationAddressCityName": "SHAMOKIN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "272-241-9069",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/23/2020",
"LastUpdateDate": "04/23/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "MSG013254",
"LicenseNumberStateCode": "PA",
"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."
}
}
}
}