{
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"FirstLineMailingAddress": "1298 OBRIEN RD",
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"MailingAddressStateName": "ID",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "150 126TH ST STE C",
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"PracticeLocationAddressCityName": "OROFINO",
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"EnumerationDate": "01/21/2026",
"LastUpdateDate": "01/21/2026",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SAMSON",
"AuthorizedOfficialFirstName": "ELIZABETH",
"AuthorizedOfficialMiddleName": "JANE",
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"AuthorizedOfficialCredential": "LMT",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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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."
}
}
}
}