{
"Npi": {
"NPI": "1265772271",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CHRIS WISMER PT GCFP LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "29 DOMINGO RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANTA FE",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87508-8256",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-231-3361",
"MailingAddressFaxNumber": "505-466-2707",
"FirstLinePracticeLocationAddress": "230 S SAINT FRANCIS DR STE 5",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SANTA FE",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "87501-2456",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-231-3361",
"PracticeLocationAddressFaxNumber": "505-989-1740",
"EnumerationDate": "02/27/2013",
"LastUpdateDate": "02/27/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WISMER",
"AuthorizedOfficialFirstName": "CHRISTINE",
"AuthorizedOfficialMiddleName": "F",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "505-231-3361",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "1265",
"LicenseNumberStateCode": "NM",
"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."
}
}
}
}