{
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"FirstLineMailingAddress": "583 GREENSCAPE CIR # 1-306",
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"FirstLinePracticeLocationAddress": "7887 WOLF RIVER BLVD",
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"PracticeLocationAddressCityName": "GERMANTOWN",
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"PracticeLocationAddressTelephoneNumber": "901-759-3111",
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"EnumerationDate": "05/15/2025",
"LastUpdateDate": "05/15/2025",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2251X0800X",
"TaxonomyName": "Orthopedic Physical Therapist",
"LicenseNumber": "PT7834",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}