Healthcare Provider Details

I. General information

NPI: 1003020744
Provider Name (Legal Business Name): DEHNING JO DEHNING MS, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 ETHETE ROAD
FORT WASHAKIE WY
82514
US

IV. Provider business mailing address

235 RIVER PL
LANDER WY
82520-3492
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-3516
  • Fax: 307-332-9116
Mailing address:
  • Phone: 307-335-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1052
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: