{
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"NameSuffix": null,
"Credential": "PHYSICAL THERAPIST",
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"FirstLineMailingAddress": "PO BOX 932184",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "151 STAGECOACH TRL STE 230",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN MARCOS",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "512-214-8202",
"PracticeLocationAddressFaxNumber": "512-214-8061",
"EnumerationDate": "09/04/2020",
"LastUpdateDate": "11/17/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "1334397",
"LicenseNumberStateCode": "TX",
"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."
}
}
}
}