Healthcare Provider Details

I. General information

NPI: 1427298405
Provider Name (Legal Business Name): WILLIAM LEMKE PHYSICAL THERAPY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PONDEROSA CT 5647 US HIGHWAY 26
DUBOIS WY
82513-9603
US

IV. Provider business mailing address

PO BOX 1353 5647 US HIGHWAY 26
DUBOIS WY
82513-1353
US

V. Phone/Fax

Practice location:
  • Phone: 307-455-2236
  • Fax: 307-455-2250
Mailing address:
  • Phone: 307-455-2236
  • Fax: 307-455-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-1150
License Number StateWY

VIII. Authorized Official

Name: WILLIAM ERVIN LEMKE
Title or Position: PHYSICAL THERAPIST
Credential: P.C.
Phone: 307-455-2236