{
"Npi": {
"NPI": "1588819171",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COUNTERPOISE PHYSICAL THERAPY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 53191",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PINOS ALTOS",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "88053-3191",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "620-318-9401",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1609 SILVER HEIGHTS BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SILVER CITY",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "88061-5643",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "602-318-9401",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/24/2008",
"LastUpdateDate": "11/24/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ESTENSEN",
"AuthorizedOfficialFirstName": "ANN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS, PT",
"AuthorizedOfficialTelephoneNumber": "602-318-9401",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "3465",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}