{
"Npi": {
"NPI": "1881769990",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ALLIS",
"FirstName": "SHELLY",
"MiddleName": "MARIE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "P.T.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "ALLIS",
"OtherFirstName": "RACHELLE",
"OtherMiddleName": "MARIE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PT",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "PO BOX 2638",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PISMO BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93448-2638",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "805-473-7499",
"MailingAddressFaxNumber": "805-473-7494",
"FirstLinePracticeLocationAddress": "271 FIVE CITIES DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PISMO BEACH",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93449-3009",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "805-473-7499",
"PracticeLocationAddressFaxNumber": "805-473-7494",
"EnumerationDate": "11/22/2006",
"LastUpdateDate": "05/31/2016",
"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": "PT 14733",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}