{
"Npi": {
"NPI": "1699480731",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CHUMLEY",
"FirstName": "CAITLIN",
"MiddleName": "BRIA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PTA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MORTON",
"OtherFirstName": "CAITLIN",
"OtherMiddleName": "BRIA",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "310 RACETRACK RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT WALTON BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32547",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-889-4550",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "310 RACETRACK RD NW",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT WALTON BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32547-1553",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "850-889-4550",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/23/2023",
"LastUpdateDate": "01/23/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225200000X",
"TaxonomyName": "Physical Therapy Assistant",
"LicenseNumber": "26674",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}