Healthcare Provider Details

I. General information

NPI: 1528953361
Provider Name (Legal Business Name): TAYLOR CANNEFAX PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 VISTA DR BLDG B
LARAMIE WY
82070-5530
US

IV. Provider business mailing address

1909 VISTA DR BLDG B
LARAMIE WY
82070-5530
US

V. Phone/Fax

Practice location:
  • Phone: 307-721-8024
  • Fax:
Mailing address:
  • Phone: 307-721-8024
  • Fax: 307-742-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: