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NPI Code Detail

MEDICARE: LEIGH VANTASSEL PTA

MEDICARE: LEIGH VANTASSEL PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantPTA-398WY

General Provider Information

NPI Number : 1124144191
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEIGH VANTASSEL PTA
Provider Business Mailing Address
First Line : 6631 E 2ND ST
Second Line :
City : CASPER
State : WY
Zip : 82609-4355
Country : US
Telephone Number : 307-268-9904
Fax Number : 307-268-9907
Provider Business Practice Location Address
First Line : 6631 E 2ND ST
Second Line :
City : CASPER
State : WY
Zip : 82609-4355
Country : US
Telephone Number : 307-268-9904
Fax Number : 307-268-9907
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 12/07/2010

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Directions to “ LEIGH VANTASSEL PTA” Practice Location

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