{
"Npi": {
"NPI": "1912515974",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CCM MASSAGE 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": "PO BOX 878",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TWIN LAKES",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53181-0878",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-684-9466",
"MailingAddressFaxNumber": "262-279-2214",
"FirstLinePracticeLocationAddress": "606 COUNTRY LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TWIN LAKES",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53181-9502",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-684-9466",
"PracticeLocationAddressFaxNumber": "262-279-2214",
"EnumerationDate": "07/16/2020",
"LastUpdateDate": "09/09/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GERLING-LMT",
"AuthorizedOfficialFirstName": "CHRISTINE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/MASSAGE THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "262-684-9466",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}