Healthcare Provider Details

I. General information

NPI: 1952484511
Provider Name (Legal Business Name): JACKSON HOLE PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/18/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SCOTT LANE
JACKSON WY
83001
US

IV. Provider business mailing address

PO BOX 1828
JACKSON WY
83001-1828
US

V. Phone/Fax

Practice location:
  • Phone: 307-734-9005
  • Fax: 307-734-4424
Mailing address:
  • Phone: 307-734-5292
  • Fax: 307-734-8834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT EARL HARMON
Title or Position: OWNER/ADMINISTRATOR
Credential: PT
Phone: 307-734-9005