{
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"FirstLineMailingAddress": "PO BOX 676",
"SecondLineMailingAddress": "600 HIGH BLVD",
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"MailingAddressStateName": "PA",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "610-796-9391",
"FirstLinePracticeLocationAddress": "600 HIGH BLVD",
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"PracticeLocationAddressCityName": "KENHORST",
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"EnumerationDate": "05/08/2017",
"LastUpdateDate": "05/08/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MATTHEWS",
"AuthorizedOfficialFirstName": "MANDIE",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "610-796-9687",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}