{
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"LastName": "BEACH",
"FirstName": "DANIEL",
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"FirstLineMailingAddress": "3599 UNIVERSITY S BLVD",
"SecondLineMailingAddress": "ATTN: MANAGED CARE",
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32216-4252",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-345-7607",
"MailingAddressFaxNumber": "904-345-7284",
"FirstLinePracticeLocationAddress": "105 MARINER HEALTH WAY",
"SecondLinePracticeLocationAddress": "SUITE 213",
"PracticeLocationAddressCityName": "SAINT AUGUSTINE",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-217-4259",
"PracticeLocationAddressFaxNumber": "904-217-4251",
"EnumerationDate": "09/19/2014",
"LastUpdateDate": "10/13/2016",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT29672",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}