{
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"FirstLineMailingAddress": "5N425 EAGLE TER",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ITASCA",
"MailingAddressStateName": "IL",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "360 W BUTTERFIELD RD STE 150",
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"PracticeLocationAddressCityName": "ELMHURST",
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"PracticeLocationAddressFaxNumber": "630-268-1047",
"EnumerationDate": "06/19/2019",
"LastUpdateDate": "06/19/2019",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COMEROUSKI",
"AuthorizedOfficialFirstName": "JOHN",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "PT",
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"Taxonomies": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
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}
}
}
}