Healthcare Provider Details

I. General information

NPI: 1093914111
Provider Name (Legal Business Name): NORTH PLATTE PHYSICAL THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 5TH ST
DOUGLAS WY
82633-2434
US

IV. Provider business mailing address

111 S 5TH ST
DOUGLAS WY
82633-2434
US

V. Phone/Fax

Practice location:
  • Phone: 307-358-9464
  • Fax: 307-358-9330
Mailing address:
  • Phone: 307-358-9464
  • Fax: 307-358-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA M MANGUS
Title or Position: CFO
Credential: CFO
Phone: 307-358-9464