{
"Npi": {
"NPI": "1548677701",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WIND RIVER PHYSICAL THERAPY 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": "364 NORTH 2ND STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LANDER",
"MailingAddressStateName": "WY",
"MailingAddressPostalCode": "82520-3033",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "307-335-5188",
"MailingAddressFaxNumber": "307-333-0600",
"FirstLinePracticeLocationAddress": "150 LINCOLN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LANDER",
"PracticeLocationAddressStateName": "WY",
"PracticeLocationAddressPostalCode": "82520-2846",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "307-335-5188",
"PracticeLocationAddressFaxNumber": "307-333-0600",
"EnumerationDate": "07/18/2014",
"LastUpdateDate": "02/02/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FRANCIS",
"AuthorizedOfficialFirstName": "TY",
"AuthorizedOfficialMiddleName": "NATHANIEL",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MPT",
"AuthorizedOfficialTelephoneNumber": "307-335-5188",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "WY-1202",
"LicenseNumberStateCode": "WY",
"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."
}
}
}
}