{
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"FirstLineMailingAddress": "25 TYLER CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPRINGBORO",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45066-8301",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "937-212-4098",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1 ELIZABETH PL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DAYTON",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45417-3445",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "937-435-3620",
"PracticeLocationAddressFaxNumber": "937-435-3660",
"EnumerationDate": "05/31/2016",
"LastUpdateDate": "11/14/2016",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAGNUSEN",
"AuthorizedOfficialFirstName": "DAVID",
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"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "937-435-3620",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208100000X",
"TaxonomyName": "Physical Medicine & Rehabilitation Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}