{
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"EIN": null,
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"FirstLineMailingAddress": "7950 MENTOR AVE APT L3",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MENTOR",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44060-5654",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "10701 EAST BLVD",
"SecondLinePracticeLocationAddress": "CARES TOWER, 1ST FLOOR",
"PracticeLocationAddressCityName": "CLEVELAND",
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"PracticeLocationAddressTelephoneNumber": "216-791-3800",
"PracticeLocationAddressFaxNumber": "261-797-7953",
"EnumerationDate": "07/01/2015",
"LastUpdateDate": "07/01/2015",
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"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapy Clinic/Center",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}