{
"Npi": {
"NPI": "1780811968",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SHANKLIN",
"FirstName": "TASHA",
"MiddleName": "MOUTON",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "OTR, PT, OCS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MOUTON",
"OtherFirstName": "TASHA",
"OtherMiddleName": "CENTRELLY",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "4500 SAN PABLO RD S",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32224-1865",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-953-2000",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4500 SAN PABLO RD S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JACKSONVILLE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32224-1865",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-953-2000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/16/2009",
"LastUpdateDate": "10/12/2020",
"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": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT26076",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}