{
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"FirstLineMailingAddress": "1049 MAILWOOD DR",
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"MailingAddressCityName": "KNIGHTDALE",
"MailingAddressStateName": "NC",
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"FirstLinePracticeLocationAddress": "7361 SIX FORKS RD STE 116",
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"PracticeLocationAddressCityName": "RALEIGH",
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"EnumerationDate": "08/26/2021",
"LastUpdateDate": "10/03/2023",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Massage Therapist",
"LicenseNumber": "15335",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}