Healthcare Provider Details

I. General information

NPI: 1033357629
Provider Name (Legal Business Name): CHRISTINA LOREE KAPER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NORTH FORK RD.
FORT WASHAKIE WY
82514-0859
US

IV. Provider business mailing address

4 NORTH FORK RD.
FORT WASHAKIE WY
82514-0859
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-6902
  • Fax: 307-332-4279
Mailing address:
  • Phone: 307-332-6902
  • Fax: 307-332-4279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number463
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: