Healthcare Provider Details

I. General information

NPI: 1457731002
Provider Name (Legal Business Name): NEW THERAPEUTIC SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S DOUGLAS HWY SUITE B-4
GILLETTE WY
82716-4924
US

IV. Provider business mailing address

1001 S DOUGLAS HWY SUITE B-4
GILLETTE WY
82716-4924
US

V. Phone/Fax

Practice location:
  • Phone: 307-682-2632
  • Fax: 307-682-2610
Mailing address:
  • Phone: 307-682-2632
  • Fax: 307-682-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. NAVE JAY YOUNG
Title or Position: OWNER / MEMBER
Credential: CMT
Phone: 307-682-2632