Healthcare Provider Details

I. General information

NPI: 1023940376
Provider Name (Legal Business Name): CLIFFORD THOMAS NEAL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 PRAIRIE AVE STE 6
CHEYENNE WY
82009-4867
US

IV. Provider business mailing address

1331 PRAIRIE AVE STE 6
CHEYENNE WY
82009-4867
US

V. Phone/Fax

Practice location:
  • Phone: 307-637-4617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2620
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: