Healthcare Provider Details

I. General information

NPI: 1811263486
Provider Name (Legal Business Name): CARESSA ANN HOWELL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NORTH FORK ROAD
FORT WASHAKIE WY
82514
US

IV. Provider business mailing address

2180 SPRIGGS DR
LANDER WY
82520-2664
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-0612
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: