{
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"EIN": null,
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"OtherCredential": "CMT",
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"FirstLineMailingAddress": "8958 EDMONSTON DR",
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"MailingAddressCityName": "BRISTOW",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "20136-1299",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "571-393-7562",
"MailingAddressFaxNumber": "571-379-5338",
"FirstLinePracticeLocationAddress": "9384 FORESTWOOD LN",
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"PracticeLocationAddressCityName": "MANASSAS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "571-393-7562",
"PracticeLocationAddressFaxNumber": "571-379-5338",
"EnumerationDate": "03/18/2013",
"LastUpdateDate": "03/18/2013",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Massage Therapist",
"LicenseNumber": "0019006616",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}